Provider Demographics
NPI:1376515825
Name:PLACEK, EVELYN (MD)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:PLACEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2547
Mailing Address - Country:US
Mailing Address - Phone:914-725-1800
Mailing Address - Fax:914-725-1840
Practice Address - Street 1:2 OVERHILL RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5323
Practice Address - Country:US
Practice Address - Phone:914-725-1800
Practice Address - Fax:914-725-1840
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165977-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06F701Medicare ID - Type Unspecified
NYD91994Medicare UPIN