Provider Demographics
NPI:1184621435
Name:HACK, EVAN R (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:R
Last Name:HACK
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:47 PUTNAM RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-5332
Mailing Address - Country:US
Mailing Address - Phone:860-355-3790
Mailing Address - Fax:860-355-3856
Practice Address - Street 1:120 PARK LN
Practice Address - Street 2:SUITE A-101
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2428
Practice Address - Country:US
Practice Address - Phone:860-355-8190
Practice Address - Fax:860-355-3856
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029133208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics