Provider Demographics
NPI:1578844635
Name:STEPHANIE BECKER, ANP-C LLC
Entity Type:Organization
Organization Name:STEPHANIE BECKER, ANP-C LLC
Other - Org Name:BRANFORD MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C
Authorized Official - Phone:973-424-0080
Mailing Address - Street 1:23 BRANFORD PLACE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2711
Mailing Address - Country:US
Mailing Address - Phone:973-424-0080
Mailing Address - Fax:973-424-0088
Practice Address - Street 1:23 BRANFORD PLACE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2711
Practice Address - Country:US
Practice Address - Phone:973-424-0080
Practice Address - Fax:973-424-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25NJ00311200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0274445Medicaid
NJ228205Medicare PIN
NJ0274445Medicaid