=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720473861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVIA G BECK PSYCHIATRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2015
-----------------------------------------------------
Last Update Date | 06/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 CEDAR DR W
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-248-1038
-----------------------------------------------------
Fax | 516-248-1038
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 CEDAR DR W
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-248-1038
-----------------------------------------------------
Fax | 516-248-1038
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LIVIA BECK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 516-248-1038
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 134415
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------