1376513093 NPI number — ISLAND ELECTROCARDIOGRAPHIC SERVICES, PC

Table of content: (NPI 1376513093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376513093 NPI number — ISLAND ELECTROCARDIOGRAPHIC SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISLAND ELECTROCARDIOGRAPHIC SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376513093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
97 NEW DORP LN
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10306-2347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-876-6220
Provider Business Mailing Address Fax Number:
718-876-5969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 SEGUINE AVE
Provider Second Line Business Practice Location Address:
STATEN ISLAND UNIVERSITY SOUTH, FLOOR 1
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10309-3932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-876-6220
Provider Business Practice Location Address Fax Number:
718-876-5969
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEFKOVIC
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
C. E. O.
Authorized Official Telephone Number:
718-876-6220

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00721426 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com