Healthcare Provider Details

I. General information

NPI: 1407878275
Provider Name (Legal Business Name): DAVID M HECKLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 MIDDLE COUNTRY ROAD
CORAM NY
11727
US

IV. Provider business mailing address

266 MIDDLE COUNTRY ROAD
CORAM NY
11727
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-1111
  • Fax: 631-698-9389
Mailing address:
  • Phone: 631-698-1111
  • Fax: 631-698-9389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1704981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: