Basic Information
| Provider Information | |||||||||
| NPI: | 1225001613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREEN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 CROSSWAYS PARK DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117972006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169383000 | ||||||||
| FaxNumber: | 5169383239 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 CROSSWAYS PARK DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117972006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169383000 | ||||||||
| FaxNumber: | 5169383239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 07/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 137059 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00890657 | 05 | NY | MEDICAID |