MEDICARE: MRS. EVGENIA USKACH PA-C

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	363AM0700X	Medical Physician Assistant	015605	NY

General Provider Information

NPI Number	:	1962749051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVGENIA USKACH PA-C

Provider Business Mailing Address
First Line	:	26 MEAGAN LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1164
Country	:	US
Telephone Number	:	646-239-7303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 HONE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1406
Country	:	US
Telephone Number	:	718-518-1133
Fax Number	:	718-518-1244

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

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	02/12/2015

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