MEDICARE: MRS. EVELYN C ALOGU ASN

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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17865305	OTHER	NY	HIP PRIME

General Provider Information

NPI Number	:	1942682992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVELYN C ALOGU ASN

Provider Business Mailing Address
First Line	:	10 ROCKWELL AVE
Second Line	:	APT 3B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1609
Country	:	US
Telephone Number	:	347-820-4826
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 ROCKWELL AVE
Second Line	:	APT 3B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1609
Country	:	US
Telephone Number	:	347-820-4826
Fax Number	:

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

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	06/26/2015

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