Provider Demographics
NPI:1386832954
Name:EKLUND, JEFFERY C I
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:C
Last Name:EKLUND
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JEFFERY
Other - Middle Name:C
Other - Last Name:EKLUND
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:510 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2515
Mailing Address - Country:US
Mailing Address - Phone:716-366-1656
Mailing Address - Fax:
Practice Address - Street 1:510 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2515
Practice Address - Country:US
Practice Address - Phone:716-366-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist