Provider Demographics
NPI:1164439964
Name:BECKER, GARY SHAWN (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SHAWN
Last Name:BECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3205
Mailing Address - Country:US
Mailing Address - Phone:732-972-2272
Mailing Address - Fax:732-972-7882
Practice Address - Street 1:2035 RALPH AVE
Practice Address - Street 2:B2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5300
Practice Address - Country:US
Practice Address - Phone:718-968-9200
Practice Address - Fax:718-444-5054
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY232785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY280ACOtherBLUE CROSS
NY280ACOtherBLUE CROSS
NYL26134Medicare UPIN