Basic Information
| Provider Information | |||||||||
| NPI: | 1558582866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LENSKY | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4216 TARZANA ESTATES DR | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913565447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189347833 | ||||||||
| FaxNumber: | 5627868613 | ||||||||
| Practice Location | |||||||||
| Address1: | 6245 DE LONGPRE AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900288253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234622271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | A86838 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 1558582866 | 01 | CA | MEDICARE | OTHER | 1558582866 | 05 | CA | MEDICAID |