Provider Demographics
NPI:1619914801
Name:ECKARDT, KAREN M (PT)
Entity type:Individual
Prefix:
First Name:KAREN M
Middle Name:
Last Name:ECKARDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3385 VETERANS MEMORIAL HWY STE I
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7660
Mailing Address - Country:US
Mailing Address - Phone:631-665-4560
Mailing Address - Fax:631-665-7213
Practice Address - Street 1:131 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8315
Practice Address - Country:US
Practice Address - Phone:631-665-4560
Practice Address - Fax:631-665-7213
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011555-1174400000X, 2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ993198821Medicare PIN