Provider Demographics
NPI:1841655297
Name:OMNICARE MULTI SPECIALTY,PC
Entity type:Organization
Organization Name:OMNICARE MULTI SPECIALTY,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVECOEUR
Authorized Official - Suffix:
Authorized Official - Credentials:CEO/ MD
Authorized Official - Phone:718-433-0044
Mailing Address - Street 1:3636 33RD ST
Mailing Address - Street 2:211
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2329
Mailing Address - Country:US
Mailing Address - Phone:718-433-0044
Mailing Address - Fax:718-433-0044
Practice Address - Street 1:765 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4203
Practice Address - Country:US
Practice Address - Phone:718-433-0044
Practice Address - Fax:718-433-4644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNICARE ANESTHESIA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177953170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty