Provider Demographics
NPI:1972559227
Name:BREIDENSTEIN, JAMES E (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:BREIDENSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 NEEB RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-4619
Mailing Address - Country:US
Mailing Address - Phone:513-921-4227
Mailing Address - Fax:513-347-5050
Practice Address - Street 1:10450 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-2780
Practice Address - Country:US
Practice Address - Phone:513-921-4227
Practice Address - Fax:513-367-8031
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0938230Medicaid
OHP00458765Medicare PIN
OHBR4230522Medicare PIN
OH4230521Medicare PIN
OHF65753Medicare UPIN
OHBR0747475Medicare ID - Type Unspecified