Healthcare Provider Details

I. General information

NPI: 1659372076
Provider Name (Legal Business Name): JUNE ELLEN BEETLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date: 03/22/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

1407 W 6TH ST
BROOKLYN NY
11204-4802
US

IV. Provider business mailing address

1407 W 6TH ST
BROOKLYN NY
11204-4802
US

V. Phone/Fax

Practice location:
  • Phone: 718-236-6994
  • Fax: 718-331-3871
Mailing address:
  • Phone: 718-236-6994
  • Fax: 718-331-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS 12813
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number322518
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: