Provider Demographics
NPI:1295824027
Name:BRIAN V. BECKER M.A.P.T.PLLC
Entity Type:Organization
Organization Name:BRIAN V. BECKER M.A.P.T.PLLC
Other - Org Name:EXCEL REHABILITATION AND SPORTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SZUFLADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-588-2100
Mailing Address - Street 1:500 PORTION RD
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4587
Mailing Address - Country:US
Mailing Address - Phone:631-588-2100
Mailing Address - Fax:631-588-2299
Practice Address - Street 1:41 JOHN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2932
Practice Address - Country:US
Practice Address - Phone:631-321-1100
Practice Address - Fax:631-321-1761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0WKL1Medicare ID - Type Unspecified