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General NPI Number Information
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NPI Number | 1043541360
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Entity Type | Organization
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Legal Business Name | ENTROVIA MEDICAL P.C.
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 6384 SAUNDERS ST SUITE #2U
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City | REGO PARK
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State | NY
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Zip | 11374-3108
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Country | US
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Telephone | 718-897-0573
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Fax |
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Provider Business Mailing Address
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Address Line | 6384 SAUNDERS ST SUITE #2U
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City | REGO PARK
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State | NY
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Zip | 11374-3108
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Country | US
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Telephone | 718-897-0573
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EVENS SAINT CYRUS
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Credential | M.D.
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Telephone | 917-270-4980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 169274
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License Number State | NY
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