Provider Demographics
NPI:1689856098
Name:ECKERSON PEDIATRIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:ECKERSON PEDIATRIC ASSOCIATES, PC
Other - Org Name:CLARKSTOWN PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-352-5511
Mailing Address - Street 1:35 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2914
Mailing Address - Country:US
Mailing Address - Phone:845-623-7100
Mailing Address - Fax:845-732-8440
Practice Address - Street 1:35 SMITH ST
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2914
Practice Address - Country:US
Practice Address - Phone:845-623-7100
Practice Address - Fax:845-732-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00515637Medicaid