Individual provider Active NPI

Mariya Evsevich, R.N

  • Registered Nurse
  • Staten Island, NY
National Provider Identifier
1871054213
Registry record updated Mar 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
766407 Issued in NY
Practice address
26 Dumont Ave
Staten Island, NY 10305-1450
Phone
(718) 667-8510
NPI assigned
Mar 28, 2019
Last updated
Mar 28, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 766407 NY Primary

Addresses

Primary practice location

26 Dumont Ave
Staten Island, NY 10305-1450

Mailing address

26 Dumont Ave
Staten Island, NY 10305-1450
Phone (718) 667-8510

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
Registered Nurse

State licenses

LicenseStateTypeSpecialty
766407NYMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553731200000",
    "number": "1871054213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 DUMONT AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103051450",
            "telephone_number": "718-667-8510",
            "fax_number": "718-667-4524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 DUMONT AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103051450",
            "telephone_number": "718-667-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVSEVICH",
        "first_name": "MARIYA",
        "credential": "R.N",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-28",
        "last_updated": "2019-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "766407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.

Verify at the official NPI Registry.