1598894743 NPI number — LONG BEACH EKG

Table of content: (NPI 1598894743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598894743 NPI number — LONG BEACH EKG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG BEACH EKG
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:
1598894743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1575 HILLSIDE AVE
Provider Second Line Business Mailing Address:
CO MDB INC STE LL3
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-354-0071
Provider Business Mailing Address Fax Number:
516-354-0415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 E BAY DR
Provider Second Line Business Practice Location Address:
LBMH
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-354-0071
Provider Business Practice Location Address Fax Number:
516-354-0415
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEITZMAN
Authorized Official First Name:
LEE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
516-432-2004

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  176667 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 128040 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 139593 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01482993 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1821058124 . This is a "LB WEITZMAN, MD (NPI)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00767813 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00237494 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1154355766 . This is a "MD CHESNER, MD (NPI)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1700854270 . This is a "JP SCHAFFER, MD (NPI)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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