Provider Demographics
NPI:1609807288
Name:BECKETT FAMILY PRACTICE
Entity Type:Organization
Organization Name:BECKETT FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAGANELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-467-2556
Mailing Address - Street 1:545 BECKETT RD.
Mailing Address - Street 2:SUITE 806
Mailing Address - City:LOGAN TWP.
Mailing Address - State:NJ
Mailing Address - Zip Code:08085
Mailing Address - Country:US
Mailing Address - Phone:856-467-2556
Mailing Address - Fax:856-467-3816
Practice Address - Street 1:545 BECKETT RD.
Practice Address - Street 2:SUITE 806
Practice Address - City:LOGAN TWP.
Practice Address - State:NJ
Practice Address - Zip Code:08085
Practice Address - Country:US
Practice Address - Phone:856-467-2556
Practice Address - Fax:856-467-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0072472002OtherAMERIHEALTH
47135OtherAETNA
NJ3340902Medicaid
47135OtherAETNA