Provider Demographics
NPI:1366022139
Name:BRUTUS, EVENS
Entity Type:Individual
Prefix:
First Name:EVENS
Middle Name:
Last Name:BRUTUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PAERDEGAT 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4110
Mailing Address - Country:US
Mailing Address - Phone:718-614-9953
Mailing Address - Fax:
Practice Address - Street 1:880 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3301
Practice Address - Country:US
Practice Address - Phone:718-613-7512
Practice Address - Fax:718-613-7564
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4596511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse