Healthcare Provider Details

I. General information

NPI: 1104372606
Provider Name (Legal Business Name): ANDREW ECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 ROUTE 70 E STE B
MARLTON NJ
08053-1855
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-596-9057
  • Fax: 856-596-0837
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00693200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR16306700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: