Provider Demographics
NPI:1487747606
Name:BECKWITH, LAVONE (MW)
Entity type:Individual
Prefix:
First Name:LAVONE
Middle Name:
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:MW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 ST. JOHN'S PLACE
Mailing Address - Street 2:APT # 52
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11338-5626
Mailing Address - Country:US
Mailing Address - Phone:718-636-9850
Mailing Address - Fax:
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:BOX 1170
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-659-8557
Practice Address - Fax:212-348-7438
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000983-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02652151Medicaid
NYM9M381Medicare ID - Type Unspecified
NY02652151Medicaid