Evergreene Mobile Phlebotomy

Primary specialty

TechnicianTaxonomy code 374700000X

Legal business name

EVERGREENE MOBILE PHLEBOTOMY

Doing business as

n/a

Practice address

116 Lafayette PL
Englewood, NJ 07631-3328

Phone

(551) 587-2323

NPI assigned

Jan 30, 2023

Last updated

Jan 30, 2023By 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

Mrs. Katima G McCullough

Title

Ceo

Phone

(551) 587-2323

Specialties & licenses 1

Addresses

Other names 1

• n/a Doing business as

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

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1912613308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 LAFAYETTE PL",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076313328",
            "telephone_number": "551-587-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 LAFAYETTE PL",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076313328",
            "telephone_number": "551-587-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREENE MOBILE PHLEBOTOMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "KATIMA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "551-587-2323",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "374700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "n/a",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ethos Wellness
• Barry Ettinger, M.D.
• Eugene Friedberg MD LLC
• Robert Paul Evans, PH.D.
• Mallory S Everett, LPC
• Eytan Chen DMD LLC (Growing Smiles of Englewood)
• Beenish Faheem, MD
• Steve R Fallek, MD
• Nancy Faltas, LCSW
• Joshua Falto, P.A.

• Technician in Englewood, NJ
• Providers in Englewood, NJ by specialty
• Technician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.