Provider Demographics
NPI:1073726378
Name:HEALTHEAST MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:HEALTHEAST MEDICAL GROUP, INC.
Other - Org Name:HEALTHEAST MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-771-1007
Mailing Address - Street 1:6300 NW 5TH WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6110
Mailing Address - Country:US
Mailing Address - Phone:954-771-1007
Mailing Address - Fax:954-771-9930
Practice Address - Street 1:6300 NW 5TH WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6110
Practice Address - Country:US
Practice Address - Phone:954-771-1007
Practice Address - Fax:954-771-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1262171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC005LOtherBCBS #