Provider Demographics
NPI:1043202401
Name:BREZNAY, MARGARET ELLEN (DC)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ELLEN
Last Name:BREZNAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LEDGE CT
Mailing Address - Street 2:
Mailing Address - City:PITTSTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18640-9521
Mailing Address - Country:US
Mailing Address - Phone:570-655-9247
Mailing Address - Fax:
Practice Address - Street 1:1125 MAIN ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641-1744
Practice Address - Country:US
Practice Address - Phone:570-457-5249
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-004907-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012858270004Medicaid
PABR1640751OtherBC/BS
PABR1640751OtherBC/BS
U31578Medicare UPIN