Provider Demographics
NPI:1316036866
Name:BECKER, GLENN ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ADAM
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 1:121 E 60TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1164
Mailing Address - Country:US
Mailing Address - Phone:212-319-6050
Mailing Address - Fax:212-838-1712
Practice Address - Street 1:121 E 60TH ST APT 2E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1164
Practice Address - Country:US
Practice Address - Phone:212-319-6050
Practice Address - Fax:212-838-1712
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1626792082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY162679OtherNY LICENSE
CAG63623OtherCA LICENSE
NYA63075Medicare UPIN
CAG63623OtherCA LICENSE