Healthcare Provider Details

I. General information

NPI: 1376513093
Provider Name (Legal Business Name): ISLAND ELECTROCARDIOGRAPHIC SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 SEGUINE AVE STATEN ISLAND UNIVERSITY SOUTH, FLOOR 1
STATEN ISLAND NY
10309-3932
US

IV. Provider business mailing address

97 NEW DORP LN SUITE A
STATEN ISLAND NY
10306-2347
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-6220
  • Fax: 718-876-5969
Mailing address:
  • Phone: 718-876-6220
  • Fax: 718-876-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD LEFKOVIC
Title or Position: C. E. O.
Credential: M. D.
Phone: 718-876-6220