Healthcare Provider Details

I. General information

NPI: 1962749051
Provider Name (Legal Business Name): EVGENIA USKACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 HONE AVE
BRONX NY
10461-1406
US

IV. Provider business mailing address

26 MEAGAN LOOP
STATEN ISLAND NY
10307-1164
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-1133
  • Fax: 718-518-1244
Mailing address:
  • Phone: 646-239-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number015605
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: