1912995341 NPI number — DR. DAVID P. ECKERT PSY.D.

Table of content: WENDY JO VAVREK PA-C (NPI 1487948493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912995341 NPI number — DR. DAVID P. ECKERT PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECKERT
Provider First Name:
DAVID
Provider Middle Name:
P.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
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:
1912995341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 BROADWAY DEPARTMENT OF MANAGED CARE ROOM 2B230
Provider Second Line Business Mailing Address:
WOODHULL MEDICAL & MENTAL HEALTH CENTER
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-963-8000
Provider Business Mailing Address Fax Number:
718-630-3122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WILLOW ST
Provider Second Line Business Practice Location Address:
WOODHULL MEDICAL & MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
ROSLYN HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11577-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-963-8000
Provider Business Practice Location Address Fax Number:
718-630-3122
Provider Enumeration Date:
10/10/2005

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: 103T00000X , with the licence number:  009144 , 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)

  • Identifier: 6135431 . This is a "UBH CLAIMS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3100074 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0084917 . This is a "GHI AND VALUEOPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: V53041 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000735976001 . This is a "ONEHEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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