MEDICARE: DR. LILIA A EVANGELISTA M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	123772	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	:	1932158862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILIA A EVANGELISTA M.D.

Provider Business Mailing Address
First Line	:	26 HAWKINS ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464-1415
Country	:	US
Telephone Number	:	718-885-1915
Fax Number	:	718-885-9221

Provider Business Practice Location Address
First Line	:	26 HAWKINS ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464-1415
Country	:	US
Telephone Number	:	718-885-1915
Fax Number	:	718-885-9221

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	03/17/2015

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