Provider Demographics
NPI:1770921579
Name:SCHLOSS, EVAN ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:ROSS
Last Name:SCHLOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:845-592-7780
Mailing Address - Fax:
Practice Address - Street 1:665 STONELEIGH AVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512
Practice Address - Country:US
Practice Address - Phone:845-279-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2792982084N0400X, 207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology