Provider Demographics
NPI:1477630390
Name:BECKER, STEPHANIE K (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BETHPAGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1515
Mailing Address - Country:US
Mailing Address - Phone:516-681-2220
Mailing Address - Fax:516-682-2214
Practice Address - Street 1:120 BETHPAGE RD STE 102
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1515
Practice Address - Country:US
Practice Address - Phone:516-681-2220
Practice Address - Fax:516-681-2214
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193672207W00000X
NY193672-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01500985Medicaid
NY01500985Medicaid
NYF67663Medicare UPIN