Provider Demographics
NPI:1568705085
Name:EVERETEZE, JUANITA (MD)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:EVERETEZE
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 1:205 W 19TH ST
Mailing Address - Street 2:6F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4012
Mailing Address - Country:US
Mailing Address - Phone:212-243-7963
Mailing Address - Fax:
Practice Address - Street 1:205 W 19TH ST
Practice Address - Street 2:6F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4012
Practice Address - Country:US
Practice Address - Phone:212-897-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine