MEDICARE: DR. VINCENT EVANGELISTA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	N004384	NY
2	213EP1101X	Primary Podiatric Medicine Podiatrist	N004384	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932152352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT EVANGELISTA DPM

Provider Business Mailing Address
First Line	:	9715 101ST AVE
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-2523
Country	:	US
Telephone Number	:	718-848-5700
Fax Number	:	718-323-0449

Provider Business Practice Location Address
First Line	:	9715 101ST AVE
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-2523
Country	:	US
Telephone Number	:	718-848-5700
Fax Number	:	718-323-0449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/26/2016

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