Provider Demographics
NPI:1548653975
Name:BECKER, MICHAEL E (RD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:BECKER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 38TH ST S
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-1519
Mailing Address - Country:US
Mailing Address - Phone:856-577-3083
Mailing Address - Fax:
Practice Address - Street 1:269 38TH ST S
Practice Address - Street 2:
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203-1519
Practice Address - Country:US
Practice Address - Phone:856-577-3083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered