Provider Demographics
NPI:1568450328
Name:BECKOFF, DEBRA (MA RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:BECKOFF
Suffix:
Gender:F
Credentials:MA RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4357
Mailing Address - Country:US
Mailing Address - Phone:516-678-7178
Mailing Address - Fax:516-678-7178
Practice Address - Street 1:3451 PARK AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4357
Practice Address - Country:US
Practice Address - Phone:516-678-7178
Practice Address - Fax:516-678-7178
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001611 1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3346550OtherOXFORD
P3345600OtherOXFORD
P3346550OtherOXFORD