Provider Demographics
NPI:1104549823
Name:EASTERN HEALTH & BEAUTY LLC
Entity type:Organization
Organization Name:EASTERN HEALTH & BEAUTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINGRONG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:732-832-2862
Mailing Address - Street 1:1653 LINCOLN HWY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3484
Mailing Address - Country:US
Mailing Address - Phone:732-832-2862
Mailing Address - Fax:732-694-3869
Practice Address - Street 1:1653 LINCOLN HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3484
Practice Address - Country:US
Practice Address - Phone:732-832-2862
Practice Address - Fax:732-694-3869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN HEALTH & BEAUTY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ05212720001Medicaid