Provider Demographics
NPI:1386765220
Name:L L AND B ELECTROCARIOGRAMS
Entity type:Organization
Organization Name:L L AND B ELECTROCARIOGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-792-0023
Mailing Address - Street 1:PO BOX 14718
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34280-4718
Mailing Address - Country:US
Mailing Address - Phone:941-792-0023
Mailing Address - Fax:
Practice Address - Street 1:5307 12TH AVENUE DR W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4229
Practice Address - Country:US
Practice Address - Phone:941-792-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63110OtherBLUECROSS BLUESHIELD
FLD58075Medicare UPIN
FL63110OtherBLUECROSS BLUESHIELD
FL00437Medicare PIN