Healthcare Provider Details

I. General information

NPI: 1225083124
Provider Name (Legal Business Name): THEODORE JAMES BEKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W MAIN ST
WYCKOFF NJ
07481-1439
US

IV. Provider business mailing address

367 HILLVIEW TER
FRANKLIN LAKES NJ
07417-1013
US

V. Phone/Fax

Practice location:
  • Phone: 201-647-9403
  • Fax: 201-847-0059
Mailing address:
  • Phone: 201-337-1888
  • Fax: 201-337-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMA039090
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: