Provider Demographics
NPI:1447415153
Name:JILLIAN BECKER MD LLC
Entity Type:Organization
Organization Name:JILLIAN BECKER MD LLC
Other - Org Name:JILLIAN GINGERELLI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGERELLI-BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-998-6100
Mailing Address - Street 1:38A RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGOTN
Mailing Address - State:NJ
Mailing Address - Zip Code:07031
Mailing Address - Country:US
Mailing Address - Phone:201-998-6100
Mailing Address - Fax:
Practice Address - Street 1:38A RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGOTN
Practice Address - State:NJ
Practice Address - Zip Code:07031
Practice Address - Country:US
Practice Address - Phone:201-998-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8367400Medicaid
NJ044853Medicare PIN
NJ8367400Medicaid