Provider Demographics
NPI:1497891675
Name:EVANS, MARK IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:IRA
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 OLD PALISADE RD
Mailing Address - Street 2:2906
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7064
Mailing Address - Country:US
Mailing Address - Phone:201-585-0686
Mailing Address - Fax:201-585-0685
Practice Address - Street 1:131 E 65TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7006
Practice Address - Country:US
Practice Address - Phone:212-744-2590
Practice Address - Fax:212-879-2606
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2261341207SG0201X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology