Provider Demographics
NPI:1154320919
Name:HEREDIA, EVELYN DEBORAH (DC)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:DEBORAH
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2039
Mailing Address - Country:US
Mailing Address - Phone:516-505-0755
Mailing Address - Fax:516-505-5353
Practice Address - Street 1:288 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2039
Practice Address - Country:US
Practice Address - Phone:516-505-0755
Practice Address - Fax:516-505-5353
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX8050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX72131Medicare PIN