Provider Demographics
NPI:1902202518
Name:BECKER, JAIME
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 EATON RD E
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2420
Mailing Address - Country:US
Mailing Address - Phone:516-783-2989
Mailing Address - Fax:
Practice Address - Street 1:2941 EATON RD E
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2420
Practice Address - Country:US
Practice Address - Phone:516-783-2989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY737515131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist