Provider Demographics
NPI:1588811533
Name:ECG CONSULTANTS OF BETHESDA LLC
Entity Type:Organization
Organization Name:ECG CONSULTANTS OF BETHESDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-641-9541
Mailing Address - Street 1:PO BOX 919331
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9331
Mailing Address - Country:US
Mailing Address - Phone:954-726-1808
Mailing Address - Fax:954-726-1820
Practice Address - Street 1:110 JFK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1146
Practice Address - Country:US
Practice Address - Phone:561-641-9541
Practice Address - Fax:561-641-3748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000634500Medicaid
FLBJ613Medicare PIN