Provider Demographics
NPI:1528056074
Name:BREVETTI, TERESA L (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:L
Last Name:BREVETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-0777
Mailing Address - Country:US
Mailing Address - Phone:718-616-3440
Mailing Address - Fax:
Practice Address - Street 1:2601 OCEAN PKWY
Practice Address - Street 2:CONEY ISLAND HOSPITAL DEPT OF SURGERY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7745
Practice Address - Country:US
Practice Address - Phone:718-616-3440
Practice Address - Fax:718-616-4436
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215288-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7955259OtherAETNA PPO ID #
NY20-0278746OtherTAX ID #
NY506A91OtherEMPIRE BCBS OF NY ID #
NY0498091OtherGHI PPO ID #
NY3622352OtherAETNA HMO ID #
NY4C8738OtherHEALTHNET ID #
NYP3608471OtherOXFORD ID #
NYP3608471OtherOXFORD ID #
NYH53066Medicare UPIN