Provider Demographics
NPI:1982936100
Name:BECKER, DANIEL P
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:BECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3693 HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1501
Mailing Address - Country:US
Mailing Address - Phone:914-962-6553
Mailing Address - Fax:914-962-6228
Practice Address - Street 1:3693 HILL BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1501
Practice Address - Country:US
Practice Address - Phone:914-962-6553
Practice Address - Fax:914-962-6228
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042848183500000X
CTPCT9323183500000X
FLPS0030024183500000X
MA22392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist