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Organization
BREITBECK PHYSICIAN MEDICINE SERVICES, PC
Active
Organization
BREITBECK PHYSICIAN MEDICINE SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE WHITMAN DO (PRESIDENT/DIRECTOR)
(337) 609-1221
Entity
Organization
Contact information
Practice address
160 E MAIN ST, PORT JERVIS, NY 12771-2114
(845) 858-7000
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05985951
—
NY
05
—
0730238
—
NJ
05
—
1037687270001
—
PA
Enumeration date
09/18/2019
Last updated
09/12/2023
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