Provider Demographics
NPI:1215077672
Name:EAST BROWN MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:EAST BROWN MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-426-1586
Mailing Address - Street 1:100 EAGLESMERE CIR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3144
Mailing Address - Country:US
Mailing Address - Phone:570-421-5111
Mailing Address - Fax:571-421-4125
Practice Address - Street 1:100 EAGLESMERE CIR
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3144
Practice Address - Country:US
Practice Address - Phone:570-421-5111
Practice Address - Fax:571-421-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011962710003Medicaid
PA584533Medicare PIN