1952614448 NPI number — EVERO CORPORATION

Table of content: (NPI 1952614448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952614448 NPI number — EVERO CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVERO CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952614448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 HILLSIDE AVE
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
WILLISTON PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11596-1746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-747-4200
Provider Business Mailing Address Fax Number:
516-747-8383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
WILLISTON PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11596-1746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-747-4200
Provider Business Practice Location Address Fax Number:
516-747-8383
Provider Enumeration Date:
07/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
CHRISTOS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-750-4483

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03234911 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com