Provider Demographics
NPI:1750589198
Name:BECKFORD, PEDRO ALFONSO (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:ALFONSO
Last Name:BECKFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-1620
Mailing Address - Country:US
Mailing Address - Phone:908-352-3391
Mailing Address - Fax:908-352-3988
Practice Address - Street 1:39 3RD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206-1620
Practice Address - Country:US
Practice Address - Phone:908-352-3391
Practice Address - Fax:908-352-3988
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03276300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0523305Medicaid
NJC54646Medicare UPIN