Provider Demographics
NPI:1700768215
Name:ECKERT, GREG
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:ECKERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 RESTORATION DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4370
Mailing Address - Country:US
Mailing Address - Phone:614-313-1624
Mailing Address - Fax:
Practice Address - Street 1:394 RESTORATION DR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-4370
Practice Address - Country:US
Practice Address - Phone:614-313-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion