Provider Demographics
NPI:1841319258
Name:EVELYN LLANOS MD PC
Entity type:Organization
Organization Name:EVELYN LLANOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-470-2572
Mailing Address - Street 1:19 SOUTHDOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2538
Mailing Address - Country:US
Mailing Address - Phone:631-470-2572
Mailing Address - Fax:631-385-1748
Practice Address - Street 1:19 SOUTHDOWN RD
Practice Address - Street 2:SUITE 16
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2538
Practice Address - Country:US
Practice Address - Phone:631-470-2572
Practice Address - Fax:631-385-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2381051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02729913Medicaid
W9FF41Medicare PIN
NYI48744Medicare UPIN