Healthcare Provider Details

I. General information

NPI: 1679897631
Provider Name (Legal Business Name): FRANK A EVANOV MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 UNION TPKE
NEW HYDE PARK NY
11040-1759
US

IV. Provider business mailing address

1300 UNION TPKE
NEW HYDE PARK NY
11040-1759
US

V. Phone/Fax

Practice location:
  • Phone: 516-352-1500
  • Fax: 516-352-1453
Mailing address:
  • Phone: 516-352-1500
  • Fax: 516-352-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number124049
License Number StateNY

VIII. Authorized Official

Name: DR. FRANK EVANOV
Title or Position: PRESIDENT
Credential: MD
Phone: 516-352-1500