Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 2673751 | NY |
NPI | 1164625901 |
---|---|
Provider Name | Dr. Evan Daniel Queler |
First Address | Park Ridge, NJ 07656-1208 |
Second Address | Nanuet, NY 10954-5288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 09/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9360332 | AETNA (01) | NY |