Provider Demographics
NPI:1144294653
Name:BECKER, DAVID SHAWN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SHAWN
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 69TH ST
Mailing Address - Street 2:#1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5431
Mailing Address - Country:US
Mailing Address - Phone:212-772-3600
Mailing Address - Fax:212-772-7370
Practice Address - Street 1:205 E 69TH ST
Practice Address - Street 2:#1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5431
Practice Address - Country:US
Practice Address - Phone:212-772-3600
Practice Address - Fax:212-772-7370
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203544207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53D131Medicare PIN
NYF39558Medicare UPIN