Provider Demographics
NPI:1831598630
Name:EKUNKE MEDICAL,PC
Entity type:Organization
Organization Name:EKUNKE MEDICAL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:EWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-246-9166
Mailing Address - Street 1:1195 ST.MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213
Mailing Address - Country:US
Mailing Address - Phone:718-246-9166
Mailing Address - Fax:718-715-1302
Practice Address - Street 1:1195 SAINT MARKS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2433
Practice Address - Country:US
Practice Address - Phone:718-246-9166
Practice Address - Fax:718-715-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1803952084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty