Provider Demographics
NPI:1477530772
Name:WILLIAM T. KONCZYNIN & DAVID M. HECKLER PHYSICIANS PC
Entity Type:Organization
Organization Name:WILLIAM T. KONCZYNIN & DAVID M. HECKLER PHYSICIANS PC
Other - Org Name:MIDDLE COUNTRY MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-698-1111
Mailing Address - Street 1:266 MIDDLE COUNTRY RD
Mailing Address - Street 2:MIDDLE COUNTRY MEDICAL CARE
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727
Mailing Address - Country:US
Mailing Address - Phone:631-698-1111
Mailing Address - Fax:631-698-1195
Practice Address - Street 1:266 MIDDLE COUNTRY RD
Practice Address - Street 2:MIDDLE COUNTRY MEDICAL CARE
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727
Practice Address - Country:US
Practice Address - Phone:631-698-1111
Practice Address - Fax:631-698-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW21661Medicare ID - Type Unspecified
A98831Medicare UPIN