=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942409768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVA GATEVA MD, PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 11/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 W 49TH ST STE 503
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-7400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-586-2100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3671 HUDSON MANOR TER 5D
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10463-1137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-601-6226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 223744-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------