Provider Demographics
NPI:1942384169
Name:POCKRISS, EVAN BARRY (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:BARRY
Last Name:POCKRISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2223
Mailing Address - Country:US
Mailing Address - Phone:516-569-2250
Mailing Address - Fax:516-569-3183
Practice Address - Street 1:571 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2223
Practice Address - Country:US
Practice Address - Phone:516-569-2250
Practice Address - Fax:516-569-3183
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics