Provider Demographics
NPI:1598945974
Name:ECKARDT JOHANNING, M.D., P.C.
Entity Type:Organization
Organization Name:ECKARDT JOHANNING, M.D., P.C.
Other - Org Name:ECKARDT JOHANNING
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ECKARDT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:518-459-3336
Mailing Address - Street 1:4 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3717
Mailing Address - Country:US
Mailing Address - Phone:518-459-3336
Mailing Address - Fax:518-459-4646
Practice Address - Street 1:4 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3718
Practice Address - Country:US
Practice Address - Phone:518-459-3336
Practice Address - Fax:518-459-4646
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ECKARDT JOHANNING, M.D. P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1752781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1144396656Medicare UPIN