Provider Demographics
NPI:1356496665
Name:EAST WEST MEDICAL CENTER PSC
Entity Type:Organization
Organization Name:EAST WEST MEDICAL CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DWEEPKUMAR
Authorized Official - Middle Name:I
Authorized Official - Last Name:BANGDIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-754-1535
Mailing Address - Street 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:PMB-362
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-754-1535
Mailing Address - Fax:787-754-1535
Practice Address - Street 1:570 CALLE CESAR GONZALEZ
Practice Address - Street 2:URB BALDRICH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3738
Practice Address - Country:US
Practice Address - Phone:787-754-1535
Practice Address - Fax:787-754-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085077Medicare PIN
PRD26677Medicare UPIN