Healthcare Provider Details

I. General information

NPI: 1528066834
Provider Name (Legal Business Name): EVELYN TOLSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: EVELYN TOLSTON MD

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

161 MADISON AVE 3A
NEW YORK NY
10016-5421
US

IV. Provider business mailing address

161 MADISON AVE 3A
NEW YORK NY
10016-5421
US

V. Phone/Fax

Practice location:
  • Phone: 646-424-0400
  • Fax: 646-742-0092
Mailing address:
  • Phone: 646-424-0400
  • Fax: 646-742-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number197743
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: