Healthcare Provider Details

I. General information

NPI: 1073773297
Provider Name (Legal Business Name): DEIRDRE COCKS ESCHLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK INTERNIST UFPC SMUMC, HSC LEVEL 15, RM 60
STONY BROOK NY
11794-8154
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1665
  • Fax:
Mailing address:
  • Phone: 631-827-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number257601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: