Provider Demographics
NPI:1992142616
Name:BECKERMANN, BART (LAC)
Entity type:Individual
Prefix:MR
First Name:BART
Middle Name:
Last Name:BECKERMANN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 10TH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-1910
Mailing Address - Country:US
Mailing Address - Phone:718-930-2219
Mailing Address - Fax:
Practice Address - Street 1:101 N 10TH ST APT 304
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1910
Practice Address - Country:US
Practice Address - Phone:917-446-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist