MEDICARE: WILLIAM T. KONCZYNIN & DAVID M. HECKLER PHYSICIANS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	170498	NY

General Provider Information

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

Provider Business Mailing Address
First Line	:	266 MIDDLE COUNTRY RD
Second Line	:	MIDDLE COUNTRY MEDICAL CARE
City	:	CORAM
State	:	NY
Zip	:	11727
Country	:	US
Telephone Number	:	631-698-1111
Fax Number	:	631-698-1195

Provider Business Practice Location Address
First Line	:	266 MIDDLE COUNTRY RD
Second Line	:	MIDDLE COUNTRY MEDICAL CARE
City	:	CORAM
State	:	NY
Zip	:	11727
Country	:	US
Telephone Number	:	631-698-1111
Fax Number	:	631-698-1195

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID M HECKLER
Credential	:	MD
Telephone Number	:	631-698-1111

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	06/19/2014

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