Provider Demographics
NPI:1376513093
Name:ISLAND ELECTROCARDIOGRAPHIC SERVICES, PC
Entity Type:Organization
Organization Name:ISLAND ELECTROCARDIOGRAPHIC SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C. E. O.
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:718-876-6220
Mailing Address - Street 1:97 NEW DORP LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2347
Mailing Address - Country:US
Mailing Address - Phone:718-876-6220
Mailing Address - Fax:718-876-5969
Practice Address - Street 1:375 SEGUINE AVE
Practice Address - Street 2:STATEN ISLAND UNIVERSITY SOUTH, FLOOR 1
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3932
Practice Address - Country:US
Practice Address - Phone:718-876-6220
Practice Address - Fax:718-876-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00721426Medicaid
NYW07821Medicare PIN
NY00710283Medicaid