Healthcare Provider Details

I. General information

NPI: 1215787924
Provider Name (Legal Business Name): EVOLVE PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JERICHO TPKE STE 1A
JERICHO NY
11753-1317
US

IV. Provider business mailing address

21318 UNION TPKE
OAKLAND GARDENS NY
11364-3522
US

V. Phone/Fax

Practice location:
  • Phone: 516-833-0309
  • Fax: 516-570-3747
Mailing address:
  • Phone: 718-465-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YOEL A ROJAS
Title or Position: MD/OWNER
Credential: MD
Phone: 718-465-3200