Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 4725 | NY |
NPI | 1053486423 |
---|---|
Provider Name | Mr. Michael Becker |
First Address | Baldwin, NY 11510-5021 |
Second Address | West Hempstead, NY 11552-2146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |