Provider Demographics
NPI:1316239700
Name:EASTWEST MEDICINE SERVICE PC
Entity type:Organization
Organization Name:EASTWEST MEDICINE SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-879-6243
Mailing Address - Street 1:137 5TH AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7142
Mailing Address - Country:US
Mailing Address - Phone:609-879-6243
Mailing Address - Fax:609-879-6243
Practice Address - Street 1:115 E 23RD ST FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4558
Practice Address - Country:US
Practice Address - Phone:212-928-8383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty