Provider Demographics
NPI:1528284445
Name:ECKSTEIN, IRVING L (DDS RPH)
Entity type:Individual
Prefix:DR
First Name:IRVING
Middle Name:L
Last Name:ECKSTEIN
Suffix:
Gender:M
Credentials:DDS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11076
Mailing Address - Country:US
Mailing Address - Phone:516-295-2006
Mailing Address - Fax:516-295-2605
Practice Address - Street 1:545 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11076
Practice Address - Country:US
Practice Address - Phone:516-295-2006
Practice Address - Fax:516-295-2605
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026909DDS1223X0400X
NY025379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Not Answered183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01176521Medicaid