Provider Demographics
NPI:1619027745
Name:MCEVOY, ROBERT JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:MCEVOY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 DEER PARK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3326
Mailing Address - Country:US
Mailing Address - Phone:631-254-0155
Mailing Address - Fax:631-254-0157
Practice Address - Street 1:1941 DEER PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-3326
Practice Address - Country:US
Practice Address - Phone:631-254-0155
Practice Address - Fax:631-254-0157
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX5403-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY925262OtherUHC
NYP33825437OtherMULTI PLAN
NY5801673OtherGHI
NY37978POtherHIP
NY925262OtherEMPIRE PLAN
NY925262OtherEMPIRE PLAN
NYU37165Medicare UPIN