| East West Medical Group Llc | |
|
208 Lifeline Rd Suite 102 Stroudsburg PA 18360-6419 | |
| (570) 420-5435 | |
| (570) 420-5437 |
| Full Name | East West Medical Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 208 Lifeline Rd, Stroudsburg, Pennsylvania |
| Authorized Official Name and Position | Parvez Memon (OWNER) |
| Authorized Official Contact | 5704205435 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East West Medical Group Llc 208 Lifeline Rd Suite 102 Stroudsburg PA 18360-6419 Ph: (570) 420-5435 | East West Medical Group Llc 208 Lifeline Rd Suite 102 Stroudsburg PA 18360-6419 Ph: (570) 420-5435 |
| NPI Number | 1346377033 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 01/26/2023 |
| Medicare PECOS PAC ID | 8729051669 |
|---|---|
| Medicare Enrollment ID | O20040818000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346377033 | NPI | - | NPPES |
| 0017538850001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD058888L (Pennsylvania) | Primary |
| 207R00000X | Internal Medicine | MD066364L (Pennsylvania) | Secondary |
| Provider Name | Parvez Memon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225181811 PECOS PAC ID: 1355440256 Enrollment ID: I20120222000383 |
| Provider Name | Sulagna De |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568515161 PECOS PAC ID: 0345349247 Enrollment ID: I20120222000426 |
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