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General NPI Number Information
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NPI Number | 1306299664
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Entity Type | Organization
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Legal Business Name | EVOLVE HEALTH AND WELLNESS
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 126 5TH AVENUE SUITE 10B
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 212-945-7300
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Fax | 646-844-7288
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Provider Business Mailing Address
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Address Line | 126 5TH AVENUE SUITE 10B
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 212-945-7300
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Fax | 646-844-7288
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Authorized Official
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Title or Position | CEO/OWNER
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Name | NINI MAI BUTLER
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Credential |
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Telephone | 212-945-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000704
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 70012360
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 003223
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25005313
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 083759
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 005245
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License Number State | NY
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