Healthcare Provider Details

I. General information

NPI: 1386189736
Provider Name (Legal Business Name): JASON EVANS R.N., CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH STREET, BROOKLYN, NY 11215
BROOKLYN NY
11215
US

IV. Provider business mailing address

23 SEELEY ST
BROOKLYN NY
11218-1009
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3000
  • Fax:
Mailing address:
  • Phone: 631-682-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number583708
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: