Provider Demographics
NPI:1841685914
Name:COLLEEN MCEVOY
Entity type:Organization
Organization Name:COLLEEN MCEVOY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MCEVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-235-1739
Mailing Address - Street 1:58 SAMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-6142
Mailing Address - Country:US
Mailing Address - Phone:631-235-1739
Mailing Address - Fax:
Practice Address - Street 1:58 SAMPSON AVE
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-6142
Practice Address - Country:US
Practice Address - Phone:631-235-1739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-05
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533285314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility