Healthcare Provider Details

I. General information

NPI: 1942856596
Provider Name (Legal Business Name): EVANS ROCHASTE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 E 86TH ST STE 4
NEW YORK NY
10028-2175
US

IV. Provider business mailing address

157 E 86TH ST STE 4
NEW YORK NY
10028-2175
US

V. Phone/Fax

Practice location:
  • Phone: 718-790-4511
  • Fax: 646-908-8707
Mailing address:
  • Phone: 718-790-4511
  • Fax: 646-809-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: