Individual
DR. VINCENT EVANGELISTA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
9715 101ST AVE, OZONE PARK, NY 11416-2523
(718) 848-5700
(718) 323-0449
Mailing address
9715 101ST AVE, OZONE PARK, NY 11416-2523
(718) 848-5700
(718) 323-0449
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
N004384
NY
213ES0103X
Foot & Ankle Surgery Podiatrist
N004384
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1120236
—
NY
Enumeration date
05/18/2006
Last updated
07/26/2016
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