Provider Demographics
NPI:1013635275
Name:BECKER, ANNE MARIE (MEDICAL TATTOO ARTIS)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:BECKER
Suffix:
Gender:F
Credentials:MEDICAL TATTOO ARTIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BLUEBERRY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2547
Mailing Address - Country:US
Mailing Address - Phone:516-993-3414
Mailing Address - Fax:
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8314
Practice Address - Country:US
Practice Address - Phone:631-968-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical