Healthcare Provider Details

I. General information

NPI: 1346309630
Provider Name (Legal Business Name): EVELYNE CUMPS-BAKST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 FIRST AVENUE METROPOLITAN HOSPITAL CENTER PEDIATRIC DEPARTMENT
NEW YORK NY
10029
US

IV. Provider business mailing address

1901 1ST AVE PEDIATRIC DEPARTMENT
NEW YORK NY
10029-7404
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6228
  • Fax: 212-423-7697
Mailing address:
  • Phone: 212-423-7080
  • Fax: 212-423-7697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number183160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: