1346266699 NPI number — DR. JONATHAN EDWARD ECKSTEIN DO

Table of content: DR. JONATHAN EDWARD ECKSTEIN DO (NPI 1346266699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346266699 NPI number — DR. JONATHAN EDWARD ECKSTEIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECKSTEIN
Provider First Name:
JONATHAN
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1346266699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 DENTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST ROCKAWAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11518-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-400-9302
Provider Business Mailing Address Fax Number:
516-400-9309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157-02 CROSS BAY BLVD.
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
HOWARD BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-403-5190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2006

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: 207Q00000X , with the licence number:  232520 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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