Healthcare Provider Details

I. General information

NPI: 1306379987
Provider Name (Legal Business Name): MR. PHILIP JOSPEH BECHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 UNION MILLS RD
BROADALBIN NY
12025-1973
US

IV. Provider business mailing address

PO BOX 854
BROADALBIN NY
12025-0854
US

V. Phone/Fax

Practice location:
  • Phone: 518-620-7533
  • Fax: 518-883-7471
Mailing address:
  • Phone: 518-620-7533
  • Fax: 518-883-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number373015896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: