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NPI Code Detail

MEDICARE: KRISTEN JEANETTE ECKERT

MEDICARE: KRISTEN JEANETTE ECKERT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistNY

General Provider Information

NPI Number : 1699386292
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN JEANETTE ECKERT
Provider Business Mailing Address
First Line : 624 HAWKINS AVE
Second Line :
City : LAKE RONKONKOMA
State : NY
Zip : 11779-2375
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 624 HAWKINS AVE
Second Line :
City : LAKE RONKONKOMA
State : NY
Zip : 11779-2375
Country : US
Telephone Number : 631-240-3579
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2020
Last Update Date : 08/17/2020

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Directions to “ KRISTEN JEANETTE ECKERT ” Practice Location

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