Provider Demographics
NPI:1346377033
Name:EAST WEST MEDICAL GROUP LLC
Entity type:Organization
Organization Name:EAST WEST MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARVEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-420-5435
Mailing Address - Street 1:208 LIFELINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-6419
Mailing Address - Country:US
Mailing Address - Phone:570-420-5435
Mailing Address - Fax:570-420-5437
Practice Address - Street 1:208 LIFELINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6419
Practice Address - Country:US
Practice Address - Phone:570-420-5435
Practice Address - Fax:570-420-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058888L207Q00000X
PAMD066364L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017538850001Medicaid
PA031496Medicare UPIN