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General NPI Number Information
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NPI Number | 1316239700
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Entity Type | Organization
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Legal Business Name | EASTWEST MEDICINE SERVICE PC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 115 E 23RD ST FL 10
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City | NEW YORK
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State | NY
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Zip | 10010-4558
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Country | US
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Telephone | 212-928-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 137 5TH AVE FL 7
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City | NEW YORK
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State | NY
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Zip | 10010-7142
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Country | US
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Telephone | 609-879-6243
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Fax | 609-879-6243
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RENEE CRANMER
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Credential |
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Telephone | 609-879-6243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 162059
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License Number State | NY
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