| Evergreen Family Medical Services,p.c. | |
|
743 58th St Brooklyn NY 11220-3916 | |
| (718) 765-0088 | |
| (718) 567-8208 |
| Full Name | Evergreen Family Medical Services,p.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 743 58th St, Brooklyn, New York |
| Authorized Official Name and Position | Raymond Chan (MEDICAL DIRETOR) |
| Authorized Official Contact | 7187650088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Family Medical Services,p.c. 743 58th St Brooklyn NY 11220-3916 Ph: (718) 765-0088 | Evergreen Family Medical Services,p.c. 743 58th St Brooklyn NY 11220-3916 Ph: (718) 765-0088 |
| NPI Number | 1891761243 |
|---|---|
| Provider Enumeration Date | 02/26/2006 |
| Last Update Date | 10/01/2012 |
| Medicare PECOS PAC ID | 4880992684 |
|---|---|
| Medicare Enrollment ID | O20160412000710 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891761243 | NPI | - | NPPES |
| 02720354 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Raymond Chan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477741981 PECOS PAC ID: 2567486822 Enrollment ID: I20060125000666 |
| Provider Name | Xiaoyu Sylvia Li |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205275799 PECOS PAC ID: 7416354527 Enrollment ID: I20210916000121 |
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