Provider Demographics
NPI:1699770081
Name:BECKER, STEPHEN ANTHONY (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4358
Mailing Address - Country:US
Mailing Address - Phone:347-374-1069
Mailing Address - Fax:732-202-6584
Practice Address - Street 1:111 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-4358
Practice Address - Country:US
Practice Address - Phone:347-374-1069
Practice Address - Fax:732-202-6584
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA506042086S0127X
NY14530412086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0836303Medicaid
NY00847916Medicaid
BE447485Medicare ID - Type Unspecified
NY00847916Medicaid