Provider Demographics
NPI:1982010286
Name:STEPHANIE K. BECKER M.D. PC
Entity Type:Organization
Organization Name:STEPHANIE K. BECKER M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-681-2220
Mailing Address - Street 1:120 BETHPAGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1515
Mailing Address - Country:US
Mailing Address - Phone:516-681-2220
Mailing Address - Fax:516-681-2214
Practice Address - Street 1:120 BETHPAGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1515
Practice Address - Country:US
Practice Address - Phone:516-681-2220
Practice Address - Fax:516-681-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01500985Medicaid
NY01500985Medicaid