Provider Demographics
NPI:1346266699
Name:ECKSTEIN, JONATHAN EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:EDWARD
Last Name:ECKSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:69 DENTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1522
Mailing Address - Country:US
Mailing Address - Phone:516-400-9302
Mailing Address - Fax:516-400-9309
Practice Address - Street 1:157-02 CROSS BAY BLVD.
Practice Address - Street 2:SUITE 204
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414
Practice Address - Country:US
Practice Address - Phone:929-403-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI27518Medicare UPIN
NY2256P1Medicare ID - Type Unspecified
NY6514VPMedicare PIN