Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 2261341 | NY |
N | 207V00000X | Obstetrician & Gynecologist | 2261341 | NY |
NPI | 1497891675 |
---|---|
Provider Name | Dr. Mark Ira Evans |
First Address | Fort Lee, NJ 07024-7064 |
Second Address | New York, NY 10021-7006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |