Provider Demographics
NPI:1295749646
Name:EAST MEDICALASSOCIATION, INC.
Entity type:Organization
Organization Name:EAST MEDICALASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:LIENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-226-2535
Mailing Address - Street 1:4155 SW 130TH AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3414
Mailing Address - Country:US
Mailing Address - Phone:305-226-2535
Mailing Address - Fax:305-226-2536
Practice Address - Street 1:4155 SW 130TH AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3414
Practice Address - Country:US
Practice Address - Phone:305-226-2535
Practice Address - Fax:305-226-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003339200Medicaid
FL21367Medicare ID - Type UnspecifiedPROVIDER NUMBER