Provider Demographics
NPI:1811012065
Name:CHIN, EVELYN (LPN)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:VEITCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:764 ALLWYN ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-379-8750
Mailing Address - Fax:
Practice Address - Street 1:764 ALLWYN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-379-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2322821164W00000X
NY653686-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYHQJOtherTSN EIN CSC
NY01771700Medicaid