Provider Demographics
NPI:1598099061
Name:EASTERN AVENUE HEALTH SOLUTIONS INC.
Entity Type:Organization
Organization Name:EASTERN AVENUE HEALTH SOLUTIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:YITZCHAK
Authorized Official - Last Name:MARKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:443-904-3424
Mailing Address - Street 1:3709 BANCROFT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-2701
Mailing Address - Country:US
Mailing Address - Phone:443-904-3424
Mailing Address - Fax:443-203-3149
Practice Address - Street 1:5920 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2730
Practice Address - Country:US
Practice Address - Phone:443-904-3424
Practice Address - Fax:443-203-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone