Basic Information
| Provider Information | |||||||||
| NPI: | 1649471608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENNETH E BRESKY DO PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10151 ENTERPRISE CENTER BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334373759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617404855 | ||||||||
| FaxNumber: | 5617404755 | ||||||||
| Practice Location | |||||||||
| Address1: | 10151 ENTERPRISE CENTER BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334373759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617404855 | ||||||||
| FaxNumber: | 5617404755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | BRESKY | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5617404855 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | OS-7434 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.