Provider Demographics
NPI:1306299664
Name:EVOLVE HEALTH, INC.
Entity type:Organization
Organization Name:EVOLVE HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIEN-PHUONG NINI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAI BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-945-7300
Mailing Address - Street 1:36 RIVINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002
Mailing Address - Country:US
Mailing Address - Phone:212-945-7300
Mailing Address - Fax:646-861-3544
Practice Address - Street 1:36 RIVINGTON ST.
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-945-7300
Practice Address - Fax:646-861-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0837591041C0700X
NY70012360111N00000X
NY25005313171100000X
NY000704171100000X
NY003223171100000X
NY005245171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty