Healthcare Provider Details

I. General information

NPI: 1528020583
Provider Name (Legal Business Name): ROBERT ECKER DDS DAVID J ENGELSON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 BRENTWOOD RD
BAYSHORE NY
11706
US

IV. Provider business mailing address

1579 BRENTWOOD RD
BAYSHORE NY
11706
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-8484
  • Fax: 631-665-3953
Mailing address:
  • Phone: 631-665-8484
  • Fax: 631-665-3953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number024886
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number024430
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID J ENGELSON
Title or Position: VP
Credential: DDS
Phone: 631-665-8484