Provider Demographics
NPI:1891828000
Name:BECKER, STUART G
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:G
Last Name:BECKER
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 1:1313 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2115
Mailing Address - Country:US
Mailing Address - Phone:516-569-6767
Mailing Address - Fax:516-567-2934
Practice Address - Street 1:1313 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2115
Practice Address - Country:US
Practice Address - Phone:516-569-6767
Practice Address - Fax:516-567-2934
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003410156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
C25961OtherBLUE CROSS BLUE SHIELD
0606020001Medicare ID - Type Unspecified