Evergreen Surgical Supply Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1127183 Issued in NY

Legal business name

EVERGREEN SURGICAL SUPPLY INC.

Practice address

5703 6TH Avenue
Brooklyn, NY 11220-3807

Phone

(718) 439-6038

Fax

(718) 439-6045

NPI assigned

Oct 6, 2006

Last updated

Aug 26, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

CHI Hong Li

Title

President

Phone

(718) 439-6038

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1184711822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5703 6TH AVENUE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203807",
            "telephone_number": "718-439-6038",
            "fax_number": "718-439-6045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5703 6TH AVENUE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203807",
            "telephone_number": "718-439-6038",
            "fax_number": "718-439-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SURGICAL SUPPLY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "CHI",
        "authorized_official_middle_name": "HONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-439-6038"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "1127183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01717591",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Wendy Evers-Velazquez, LCSW
• Kerri Evers, DOULA
• Camille Joy Eversley, LMSW
• Samel Samona Eversley
• Eversoft Inc

• Durable Medical Equipment & Medical Supplies in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Durable Medical Equipment & Medical Supplies in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.