Healthcare Provider Details

I. General information

NPI: 1770921579
Provider Name (Legal Business Name): EVAN ROSS SCHLOSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 STONELEIGH AVE
CARMEL NY
10512
US

IV. Provider business mailing address

110 S BEDFORD RD
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-2000
  • Fax:
Mailing address:
  • Phone: 845-592-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number279298
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number279298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: