Provider Demographics
NPI:1619359015
Name:BECHARD, RICKY
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:BECHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 STELTZER RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-3386
Mailing Address - Country:US
Mailing Address - Phone:518-593-1211
Mailing Address - Fax:
Practice Address - Street 1:70 STELTZER RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3386
Practice Address - Country:US
Practice Address - Phone:518-593-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27-0047758Medicaid