Provider Demographics
NPI:1598894743
Name:LONG BEACH EKG
Entity Type:Organization
Organization Name:LONG BEACH EKG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-432-2004
Mailing Address - Street 1:1575 HILLSIDE AVE
Mailing Address - Street 2:CO MDB INC STE LL3
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2501
Mailing Address - Country:US
Mailing Address - Phone:516-354-0071
Mailing Address - Fax:516-354-0415
Practice Address - Street 1:455 E BAY DR
Practice Address - Street 2:LBMH
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2301
Practice Address - Country:US
Practice Address - Phone:516-354-0071
Practice Address - Fax:516-354-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139593207RC0000X
NY176667207RC0000X
NY128040207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01482993Medicaid
NY1821058124OtherLB WEITZMAN, MD (NPI)
NY00767813Medicaid
NY00237494Medicaid
NY1154355766OtherMD CHESNER, MD (NPI)
NY1700854270OtherJP SCHAFFER, MD (NPI)
NYF52744Medicare UPIN
NY1700854270OtherJP SCHAFFER, MD (NPI)
NY01482993Medicaid
NYW19821Medicare ID - Type UnspecifiedLONG BEACH EKG
NY00767813Medicaid
NY00237494Medicaid
NY85A091Medicare ID - Type UnspecifiedLEE B WEITZMAN, MD