Provider Demographics
NPI:1770963183
Name:EAST-WEST MEDICAL CARE OF NEW JERSEY LLC
Entity type:Organization
Organization Name:EAST-WEST MEDICAL CARE OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:INCREMONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-517-8914
Mailing Address - Street 1:560 MAIN ST
Mailing Address - Street 2:UNIT 1E
Mailing Address - City:LOCH ARBOUR
Mailing Address - State:NJ
Mailing Address - Zip Code:07711-1231
Mailing Address - Country:US
Mailing Address - Phone:732-517-8914
Mailing Address - Fax:
Practice Address - Street 1:560 MAIN ST
Practice Address - Street 2:UNIT 1E
Practice Address - City:LOCH ARBOUR
Practice Address - State:NJ
Practice Address - Zip Code:07711-1231
Practice Address - Country:US
Practice Address - Phone:732-517-8914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05681000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ736025YJ7LMedicare PIN
NJ1992752810Medicare UPIN