Provider Demographics
NPI:1962640045
Name:BATES, EVAN MICHAEL (BSW INTERN)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:MICHAEL
Last Name:BATES
Suffix:
Gender:M
Credentials:BSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RICHLEE DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1562
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 REMSEN ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2605
Practice Address - Country:US
Practice Address - Phone:518-235-1100
Practice Address - Fax:518-235-0079
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program