Provider Demographics
NPI:1447394523
Name:ECKER PLASTIC SURGERY ASSOC INC
Entity Type:Organization
Organization Name:ECKER PLASTIC SURGERY ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ECKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:570-322-4779
Mailing Address - Street 1:920 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701
Mailing Address - Country:US
Mailing Address - Phone:570-322-4779
Mailing Address - Fax:570-322-3196
Practice Address - Street 1:920 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701
Practice Address - Country:US
Practice Address - Phone:570-322-4779
Practice Address - Fax:570-322-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021034E208200000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072535OtherFIRST PRIORITY HEALTH
PA132338OtherBLUE SHIELD
PAB37793Medicare UPIN