Provider Demographics
NPI:1669559043
Name:SWOBODA, EVA (MD)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:SWOBODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK MEDICINE HSC LEVEL 9 ROOM 090, DEPT OBGYN
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-4686
Mailing Address - Fax:
Practice Address - Street 1:140 N. BELLE MEAD RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4047
Practice Address - Country:US
Practice Address - Phone:631-444-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235565207VF0040X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI48591Medicare UPIN
NY814E31Medicare ID - Type Unspecified