Provider Demographics
NPI:1992132930
Name:POLYMERIS, EVAN N (DDS, FICOI)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:N
Last Name:POLYMERIS
Suffix:
Gender:M
Credentials:DDS, FICOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 29TH ST
Mailing Address - Street 2:APT 3F
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1642
Mailing Address - Country:US
Mailing Address - Phone:917-566-8341
Mailing Address - Fax:
Practice Address - Street 1:60 E 56TH ST
Practice Address - Street 2:SUITE #501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3204
Practice Address - Country:US
Practice Address - Phone:212-223-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0569961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist