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Individual

EVAN T REBILLOT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
1300 YORK AVE, NEW YORK, NY 10065-4805
(845) 926-4968
Mailing address
415 BUSHWICK AVE, BROOKLYN, NY 11206-3729
(330) 806-7967

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary

Other

Enumeration date
01/22/2016
Last updated
01/22/2016
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