Provider Demographics
NPI:1912991399
Name:BROIKOS, EVELYN S (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:S
Last Name:BROIKOS
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 1:2250 TURK HILL RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564
Mailing Address - Country:US
Mailing Address - Phone:585-425-2820
Mailing Address - Fax:
Practice Address - Street 1:2066 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-4300
Practice Address - Country:US
Practice Address - Phone:585-922-2800
Practice Address - Fax:585-922-2866
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01674042Medicaid