Provider Demographics
NPI:1407041049
Name:EAST RIVER INTERNATIONAL
Entity Type:Organization
Organization Name:EAST RIVER INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING / INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-923-2943
Mailing Address - Street 1:555 WASHINGTON AVE
Mailing Address - Street 2:SUITE350
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6607
Mailing Address - Country:US
Mailing Address - Phone:305-604-5707
Mailing Address - Fax:
Practice Address - Street 1:13757 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-8125
Practice Address - Country:US
Practice Address - Phone:305-234-9737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty