Provider Demographics
NPI:1669557625
Name:BREM, HAROLD (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:BREM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 JOHNSON AVE
Mailing Address - Street 2:APT. 3D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4925
Mailing Address - Country:US
Mailing Address - Phone:917-992-4017
Mailing Address - Fax:
Practice Address - Street 1:2500 JOHNSON AVE
Practice Address - Street 2:APT. 3D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4925
Practice Address - Country:US
Practice Address - Phone:917-992-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200972NY208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01187668Medicaid
NYE20178Medicare UPIN
NY71L821Medicare ID - Type Unspecified