Provider Demographics
NPI:1194966291
Name:MICHAEL J. EVEROSKI M.D. P.C.
Entity type:Organization
Organization Name:MICHAEL J. EVEROSKI M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:EVEROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-333-4100
Mailing Address - Street 1:990 WESTBURY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5309
Mailing Address - Country:US
Mailing Address - Phone:516-333-4100
Mailing Address - Fax:
Practice Address - Street 1:990 WESTBURY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5309
Practice Address - Country:US
Practice Address - Phone:516-333-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty