Provider Demographics
NPI:1740238922
Name:MEDIS EAST, INC
Entity Type:Organization
Organization Name:MEDIS EAST, INC
Other - Org Name:SILVERCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-359-5600
Mailing Address - Street 1:15005 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3846
Mailing Address - Country:US
Mailing Address - Phone:718-359-5600
Mailing Address - Fax:
Practice Address - Street 1:15005 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3846
Practice Address - Country:US
Practice Address - Phone:718-359-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02065483332BC3200X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02065483Medicaid
NY=========OtherATLANTIS HEALTH PLAN
=========OtherCAREPLUS
NY=========OtherMETROPLUS
NY=========OtherHEALTH FIRST
NY=========OtherMULTIPLAN
NY=========Other1199
NY=========OtherOXFORD HEALTH PLAN
NY=========OtherCENTERCARE
NY=========OtherCENTERCARE