Provider Demographics
NPI:1821012139
Name:EVEROSKI, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:EVEROSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MANITOU TRAIL
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754
Mailing Address - Country:US
Mailing Address - Phone:631-648-3951
Mailing Address - Fax:
Practice Address - Street 1:990 WESTBURY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-333-4100
Practice Address - Fax:516-333-4255
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207485208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01972605Medicaid