Provider Demographics
NPI:1538300934
Name:GEVANS MEDICAL PRACTICE P.C
Entity Type:Organization
Organization Name:GEVANS MEDICAL PRACTICE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-385-9399
Mailing Address - Street 1:1280 GIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2924
Mailing Address - Country:US
Mailing Address - Phone:347-449-5936
Mailing Address - Fax:347-449-5937
Practice Address - Street 1:1280 GIVAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2924
Practice Address - Country:US
Practice Address - Phone:347-449-5936
Practice Address - Fax:347-449-5937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232053207R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI20130Medicare UPIN