Provider Demographics
NPI:1699031070
Name:EVANS, JOSEPH TYRONE (RPA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:TYRONE
Last Name:EVANS
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 128TH ST
Mailing Address - Street 2:2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3003
Mailing Address - Country:US
Mailing Address - Phone:191-737-1499
Mailing Address - Fax:212-966-7160
Practice Address - Street 1:101 W 128TH ST
Practice Address - Street 2:2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3003
Practice Address - Country:US
Practice Address - Phone:191-737-1499
Practice Address - Fax:212-966-7160
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000572-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist