Provider Demographics
NPI:1578191888
Name:ECCLESTON, JOHN (EMT-B)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ECCLESTON
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DUER LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3014
Mailing Address - Country:US
Mailing Address - Phone:646-247-1548
Mailing Address - Fax:
Practice Address - Street 1:15 DUER LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3014
Practice Address - Country:US
Practice Address - Phone:646-247-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106939146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic