Provider Demographics
NPI:1992471189
Name:BECKLES PRIMARY CARE PLLC
Entity type:Organization
Organization Name:BECKLES PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-967-8448
Mailing Address - Street 1:344 E 51ST ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3522
Mailing Address - Country:US
Mailing Address - Phone:347-967-8448
Mailing Address - Fax:
Practice Address - Street 1:40 W 135TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2530
Practice Address - Country:US
Practice Address - Phone:212-283-5118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty