Provider Demographics
NPI:1255395869
Name:BROBBEY, EVELYN (GNP)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:BROBBEY
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SOUTH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3404
Mailing Address - Country:US
Mailing Address - Phone:718-477-4726
Mailing Address - Fax:718-477-4129
Practice Address - Street 1:6110 QUEENS BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5776
Practice Address - Country:US
Practice Address - Phone:212-609-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340543363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q34609Medicare UPIN
0909G1Medicare ID - Type Unspecified