Provider Demographics
NPI:1295744357
Name:EVANS, RONDAI (MD)
Entity type:Individual
Prefix:
First Name:RONDAI
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:117 DECATUR ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2513
Mailing Address - Country:US
Mailing Address - Phone:718-455-2295
Mailing Address - Fax:718-455-2297
Practice Address - Street 1:117 DECATUR ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2513
Practice Address - Country:US
Practice Address - Phone:718-455-2295
Practice Address - Fax:718-455-2297
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY212050207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02152312Medicaid
NYH35663Medicare UPIN
NY04517Medicare ID - Type Unspecified
NY02152312Medicaid