MEDICARE: MRS. DEBRA BECKOFF MA RD CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	001611 1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P3346550	OTHER		OXFORD
2	P3345600	OTHER		OXFORD

General Provider Information

NPI Number	:	1568450328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA BECKOFF MA RD CDN

Provider Business Mailing Address
First Line	:	3451 PARK AVE
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-4357
Country	:	US
Telephone Number	:	516-678-7178
Fax Number	:	516-678-7178

Provider Business Practice Location Address
First Line	:	3451 PARK AVE
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-4357
Country	:	US
Telephone Number	:	516-678-7178
Fax Number	:	516-678-7178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	12/09/2012

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