Provider Demographics
NPI:1962208728
Name:EVGENIKOS, VIANNA
Entity type:Individual
Prefix:
First Name:VIANNA
Middle Name:
Last Name:EVGENIKOS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 JACKSON ST APT 631
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6975
Mailing Address - Country:US
Mailing Address - Phone:862-354-4044
Mailing Address - Fax:
Practice Address - Street 1:5 REGENT ST STE 509
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1682
Practice Address - Country:US
Practice Address - Phone:973-974-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15213200363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care