Healthcare Provider Details

I. General information

NPI: 1902737190
Provider Name (Legal Business Name): EVOLIMB TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BRYANT AVE APT 6DF
WHITE PLAINS NY
10605-1916
US

IV. Provider business mailing address

90 BRYANT AVE APT 6DF
WHITE PLAINS NY
10605-1916
US

V. Phone/Fax

Practice location:
  • Phone: 914-606-0079
  • Fax: 845-236-3704
Mailing address:
  • Phone: 914-606-0079
  • Fax: 845-236-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD ANTHONY ALLEN
Title or Position: ORTHOTIST PROSTHETIST
Credential: BOCPO
Phone: 914-606-0079