Provider Demographics
NPI:1013226554
Name:HEIGHTS SURGICARE
Entity Type:Organization
Organization Name:HEIGHTS SURGICARE
Other - Org Name:HEIGHTS SURGICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN /CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVECOEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-433-0044
Mailing Address - Street 1:PO BOX 30037
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-0037
Mailing Address - Country:US
Mailing Address - Phone:718-433-0044
Mailing Address - Fax:718-433-4644
Practice Address - Street 1:629 W 185TH ST 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3102
Practice Address - Country:US
Practice Address - Phone:718-433-0044
Practice Address - Fax:718-433-4644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKLYN ANESTHESIA GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-01
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 261QA1903X
NY177953-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical