Provider Demographics
NPI:1609313667
Name:ELISE M BRETT MD PC
Entity type:Organization
Organization Name:ELISE M BRETT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:
Authorized Official - Last Name:BESGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-437-5850
Mailing Address - Street 1:1192 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1314
Mailing Address - Country:US
Mailing Address - Phone:212-831-1371
Mailing Address - Fax:
Practice Address - Street 1:1192 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1314
Practice Address - Country:US
Practice Address - Phone:212-831-1371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10128207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty