Provider Demographics
NPI:1598000911
Name:JOSEPH, ECKNER B (LPN)
Entity Type:Individual
Prefix:MR
First Name:ECKNER
Middle Name:B
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JUDITH DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-4029
Mailing Address - Country:US
Mailing Address - Phone:631-433-2516
Mailing Address - Fax:
Practice Address - Street 1:16 JUDITH DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4029
Practice Address - Country:US
Practice Address - Phone:631-433-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312017164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse