Provider Demographics
NPI:1083837108
Name:BECKER, SAMUEL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:SCOTT
Last Name:BECKER
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 1:5 PLAINSBORO RD STE 360
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1915
Mailing Address - Country:US
Mailing Address - Phone:609-831-0807
Mailing Address - Fax:609-831-0806
Practice Address - Street 1:5 PLAINSBORO RD STE 360
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1915
Practice Address - Country:US
Practice Address - Phone:609-831-0807
Practice Address - Fax:609-831-0806
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD450265207Y00000X
NJ25MA083408207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ126438R01Medicare PIN