Provider Demographics
NPI:1366496259
Name:EAST END ENDOCRINE ASSOCIATES PC
Entity Type:Organization
Organization Name:EAST END ENDOCRINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-288-7120
Mailing Address - Street 1:189 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-1901
Mailing Address - Country:US
Mailing Address - Phone:631-288-7120
Mailing Address - Fax:631-288-7124
Practice Address - Street 1:189 MAIN RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1901
Practice Address - Country:US
Practice Address - Phone:631-288-7120
Practice Address - Fax:631-288-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201208207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01800471Medicaid
NY26N741Medicare ID - Type Unspecified
NY01800471Medicaid