Provider Demographics
NPI:1528020583
Name:ROBERT ECKER DDS DAVID J ENGELSON DDS PC
Entity Type:Organization
Organization Name:ROBERT ECKER DDS DAVID J ENGELSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENGELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-665-8484
Mailing Address - Street 1:1579 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BAYSHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-665-8484
Mailing Address - Fax:631-665-3953
Practice Address - Street 1:1579 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BAYSHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-8484
Practice Address - Fax:631-665-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024430122300000X
NY024886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty