Provider Demographics
NPI:1629008578
Name:EAST PANACEA, LLC
Entity Type:Organization
Organization Name:EAST PANACEA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUNXIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-428-2860
Mailing Address - Street 1:3918 211TH ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1958
Mailing Address - Country:US
Mailing Address - Phone:718-428-2860
Mailing Address - Fax:
Practice Address - Street 1:3918 211TH ST
Practice Address - Street 2:2ND FL
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1958
Practice Address - Country:US
Practice Address - Phone:718-428-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies