Healthcare Provider Details

I. General information

NPI: 1417701459
Provider Name (Legal Business Name): KATHERINE BECERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 ROBINSON AVE
NEWBURGH NY
12550-3337
US

IV. Provider business mailing address

519 GRAND AVE
NEWBURGH NY
12550-1928
US

V. Phone/Fax

Practice location:
  • Phone: 845-569-8900
  • Fax:
Mailing address:
  • Phone: 845-549-3179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number065699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: