Provider Demographics
NPI:1518716075
Name:BECKER, MICHAEL J (RN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:BECKER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39 GRAND OFFENBACH ST
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3884
Mailing Address - Country:US
Mailing Address - Phone:631-747-4676
Mailing Address - Fax:
Practice Address - Street 1:197 HALF HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5861
Practice Address - Country:US
Practice Address - Phone:631-370-1700
Practice Address - Fax:631-370-1714
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY852914163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent