Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | N005657 | NY |
Y | 213ES0131X | Foot Surgery | N005657 | NY |
NPI | 1023097052 |
---|---|
Provider Name | Dr. Evan Breth |
First Address | Brooklyn, NY 11234-5515 |
Second Address | Brooklyn, NY 11234-5515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 17/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02063578 | (05) | NY |
U80879 | (02) | NY |