Active NPI
Laurelle Ann Evangelista, M.S.
- Specialist
- New York, NY
National Provider Identifier
1306109764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1106522
- Practice address
- 465 Grand St
New York, NY 10002-4800 - Phone
- (212) 420-1999
- NPI assigned
- Jun 20, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1106522 | NY | Primary |
Addresses
Primary practice location
465 Grand St
New York, NY 10002-4800
Mailing address
12 Meadow Haven LN
East Northport, NY 11731-6511
Phone (631) 241-1709
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1106522 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560816000000",
"number": "1306109764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 MEADOW HAVEN LN",
"city": "EAST NORTHPORT",
"state": "NY",
"postal_code": "117316511",
"telephone_number": "631-241-1709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "465 GRAND ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100024800",
"telephone_number": "212-420-1999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANGELISTA",
"first_name": "LAURELLE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-20",
"last_updated": "2019-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "1106522",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.