Provider Demographics
NPI:1326255035
Name:EUGENE L EVANS JR MD LLC
Entity Type:Organization
Organization Name:EUGENE L EVANS JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:LUDWIG
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:973-758-0044
Mailing Address - Street 1:2 WEST NORTHFIELD ROAD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-758-0044
Mailing Address - Fax:973-758-0055
Practice Address - Street 1:2 WEST NORTHFIELD ROAD
Practice Address - Street 2:SUITE 211
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-758-0044
Practice Address - Fax:973-758-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06972500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ044862WGEOtherMEDICARE RENDERING PROVIDER NUMBER
044862Medicare ID - Type Unspecified
NJ110408Medicare PIN
NJ044862WGEOtherMEDICARE RENDERING PROVIDER NUMBER