Provider Demographics
NPI:1336194281
Name:AKKER, ELEONORA (DO)
Entity Type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:AKKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 BRIGHTON 4TH ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6792
Mailing Address - Country:US
Mailing Address - Phone:718-373-4981
Mailing Address - Fax:718-373-4981
Practice Address - Street 1:2720 SURF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1913
Practice Address - Country:US
Practice Address - Phone:718-714-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234387208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02739119Medicaid
I54046Medicare UPIN