Provider Demographics
NPI:1053351973
Name:CREVECOEUR, EVANS (MD)
Entity type:Individual
Prefix:DR
First Name:EVANS
Middle Name:
Last Name:CREVECOEUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30037
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-0037
Mailing Address - Country:US
Mailing Address - Phone:718-433-0044
Mailing Address - Fax:646-680-0576
Practice Address - Street 1:8900 VAN WYCK EXPY
Practice Address - Street 2:JAMAICA ANESTHESIA ASSOCIATES PC
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2897
Practice Address - Country:US
Practice Address - Phone:718-206-6088
Practice Address - Fax:718-206-8087
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177953207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01424253Medicaid
NY0166AAMedicare ID - Type Unspecified
NY01424253Medicaid