Healthcare Provider Details

I. General information

NPI: 1982936100
Provider Name (Legal Business Name): DANIEL P BECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3693 HILL BLVD
JEFFERSON VALLEY NY
10535-1501
US

IV. Provider business mailing address

3693 HILL BLVD
JEFFERSON VALLEY NY
10535-1501
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-6553
  • Fax: 914-962-6228
Mailing address:
  • Phone: 914-962-6553
  • Fax: 914-962-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042848
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT9323
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0030024
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22392
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: