Provider Demographics
NPI:1649343906
Name:ECKSTEIN-STRANEVA, JO A (ANP)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:A
Last Name:ECKSTEIN-STRANEVA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JO
Other - Middle Name:A
Other - Last Name:STRANEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:169 RIVERSIDE DR
Mailing Address - Street 2:BREAST CARE CENTER
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-798-6161
Mailing Address - Fax:607-798-6111
Practice Address - Street 1:169 RIVERSIDE DR
Practice Address - Street 2:BREAST CARE CENTER
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4246
Practice Address - Country:US
Practice Address - Phone:607-798-6161
Practice Address - Fax:607-798-6111
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300663363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S74285Medicare UPIN
NYBB4027Medicare ID - Type Unspecified