1861616005 NPI number — MR. AMONEETA S BECKSTEIN MHP, BA

Table of content: MR. AMONEETA S BECKSTEIN MHP, BA (NPI 1861616005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861616005 NPI number — MR. AMONEETA S BECKSTEIN MHP, BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKSTEIN
Provider First Name:
AMONEETA
Provider Middle Name:
S
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MHP, BA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861616005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
186 GATES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62975-2506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-559-4125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 E VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62995-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-658-2611
Provider Business Practice Location Address Fax Number:
618-658-2501
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com