Provider Demographics
NPI:1255736740
Name:ICZKOVITZ, LESLIE (LMT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ICZKOVITZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 ALA MOANA BLVD
Mailing Address - Street 2:SUITE 2304
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4215
Mailing Address - Country:US
Mailing Address - Phone:808-523-8449
Mailing Address - Fax:808-356-0832
Practice Address - Street 1:1350 ALA MOANA BLVD
Practice Address - Street 2:SUITE 2304
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4215
Practice Address - Country:US
Practice Address - Phone:808-523-8449
Practice Address - Fax:808-356-0832
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 12054247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other