Healthcare Provider Details

I. General information

NPI: 1225120272
Provider Name (Legal Business Name): ZVI M ECKSTEIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 VICTORY BLVD SUITE D
STATEN ISLAND NY
10301-3914
US

IV. Provider business mailing address

1460 VICTORY BLVD SUITE D
STATEN ISLAND NY
10301-3914
US

V. Phone/Fax

Practice location:
  • Phone: 718-556-3500
  • Fax: 718-556-4750
Mailing address:
  • Phone: 718-556-3500
  • Fax: 718-556-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number215424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: