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General NPI Number Information
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NPI Number | 1295516409
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Entity Type | Organization
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Legal Business Name | EVERGREEN MEDICAL GROUP PC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 887 KINDERKAMACK RD STE 2
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2307
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Country | US
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Telephone | 201-464-0860
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Fax | 888-440-2752
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Provider Business Mailing Address
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Address Line | 887 KINDERKAMACK RD STE 2
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2307
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Country | US
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Telephone | 201-464-0860
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRIGORY SHTENDER
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Credential | MD
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Telephone | 201-791-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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