Provider Demographics
NPI:1144251893
Name:ST HILL, DE LYS EVA (MD)
Entity type:Individual
Prefix:
First Name:DE LYS
Middle Name:EVA
Last Name:ST HILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W 132ND ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3220
Mailing Address - Country:US
Mailing Address - Phone:646-241-7910
Mailing Address - Fax:917-456-3543
Practice Address - Street 1:2182 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5902
Practice Address - Country:US
Practice Address - Phone:908-851-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178853208100000X, 208D00000X
NJ25MA09606500208D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01618313Medicaid
NYF31415Medicare UPIN
NY21Z601Medicare ID - Type Unspecified