Provider Demographics
NPI:1306379987
Name:BECHARD, PHILIP JOSPEH
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JOSPEH
Last Name:BECHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-0854
Mailing Address - Country:US
Mailing Address - Phone:518-620-7533
Mailing Address - Fax:518-883-7471
Practice Address - Street 1:139 UNION MILLS RD
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-1973
Practice Address - Country:US
Practice Address - Phone:518-620-7533
Practice Address - Fax:518-883-7471
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY373015896344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04222551Medicaid