Provider Demographics
NPI:1356711949
Name:BECKER, TESS MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:MARIE
Last Name:BECKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 5TH AVE # P6-320
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6503
Mailing Address - Country:US
Mailing Address - Phone:212-241-7286
Mailing Address - Fax:
Practice Address - Street 1:1184 5TH AVE # P6-320
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-7286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019079207RI0011X, 2080P0202X, 2086S0129X
NY019079-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery