Healthcare Provider Details

I. General information

NPI: 1801903976
Provider Name (Legal Business Name): NANCY RUTH EKELMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARK AVENUE SOUTH SUITE 202
NEW YORK NY
10003
US

IV. Provider business mailing address

250 PARK AVENUE SOUTH SUITE 202
NEW YORK NY
10003
US

V. Phone/Fax

Practice location:
  • Phone: 212-505-8787
  • Fax: 212-505-8805
Mailing address:
  • Phone: 212-505-8787
  • Fax: 212-505-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number041923
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: