Provider Demographics
NPI:1255420964
Name:INCITTI, EVELYN L (RPA-C)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:L
Last Name:INCITTI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 ERIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:518-377-1779
Practice Address - Street 1:1405 FULTON AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-1402
Practice Address - Country:US
Practice Address - Phone:518-243-1313
Practice Address - Fax:518-831-7007
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0026511363A00000X
NYF000326-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid
NYR96845Medicare UPIN
NYPA 1955Medicare PIN