Provider Demographics
NPI:1770541120
Name:BECKHARDT, RUSSELL N (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:N
Last Name:BECKHARDT
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 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:3119 NEWTOWN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1350
Practice Address - Country:US
Practice Address - Phone:718-971-2489
Practice Address - Fax:718-971-2489
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179767207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E90905Medicare UPIN