Healthcare Provider Details

I. General information

NPI: 1568469831
Provider Name (Legal Business Name): KRISTI F BECK MEDICAL DOCTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PARK LN SUITE A-101
NEW MILFORD CT
06776-2428
US

IV. Provider business mailing address

29 WOOD CREEK RD
NEW MILFORD CT
06776-5138
US

V. Phone/Fax

Practice location:
  • Phone: 860-355-8190
  • Fax: 860-355-3856
Mailing address:
  • Phone: 860-210-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042396
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: