MEDICARE: DR. GARY STEVEN EVANS D.P.M.

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	N003637	NY

General Provider Information

NPI Number	:	1992703342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY STEVEN EVANS D.P.M.

Provider Business Mailing Address
First Line	:	1 PENN PLZ
Second Line	:	SUITE 1707
City	:	NEW YORK
State	:	NY
Zip	:	10119-0002
Country	:	US
Telephone Number	:	212-279-0086
Fax Number	:	212-279-6401

Provider Business Practice Location Address
First Line	:	1 PENN PLZ
Second Line	:	SUITE 1707
City	:	NEW YORK
State	:	NY
Zip	:	10119-0002
Country	:	US
Telephone Number	:	212-279-0086
Fax Number	:	212-279-6401

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/21/2008

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