Healthcare Provider Details

I. General information

NPI: 1477530772
Provider Name (Legal Business Name): WILLIAM T. KONCZYNIN & DAVID M. HECKLER PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 MIDDLE COUNTRY RD MIDDLE COUNTRY MEDICAL CARE
CORAM NY
11727
US

IV. Provider business mailing address

266 MIDDLE COUNTRY RD MIDDLE COUNTRY MEDICAL CARE
CORAM NY
11727
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-1111
  • Fax: 631-698-1195
Mailing address:
  • Phone: 631-698-1111
  • Fax: 631-698-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number170498
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID M HECKLER
Title or Position: OWNER
Credential: MD
Phone: 631-698-1111