Healthcare Provider Details

I. General information

NPI: 1346377033
Provider Name (Legal Business Name): EAST WEST MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LIFELINE RD SUITE 102
STROUDSBURG PA
18360-6419
US

IV. Provider business mailing address

208 LIFELINE RD SUITE 102
STROUDSBURG PA
18360-6419
US

V. Phone/Fax

Practice location:
  • Phone: 570-420-5435
  • Fax: 570-420-5437
Mailing address:
  • Phone: 570-420-5435
  • Fax: 570-420-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD058888L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD066364L
License Number StatePA

VIII. Authorized Official

Name: PARVEZ MEMON
Title or Position: OWNER
Credential: MD
Phone: 570-420-5435