Healthcare Provider Details

I. General information

NPI: 1619914801
Provider Name (Legal Business Name): KAREN M ECKARDT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W MAIN ST
BAY SHORE NY
11706-8315
US

IV. Provider business mailing address

3385 VETERANS MEMORIAL HWY STE I
RONKONKOMA NY
11779-7660
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-4560
  • Fax: 631-665-7213
Mailing address:
  • Phone: 631-665-4560
  • Fax: 631-665-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number011555-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number011555-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: