Provider Demographics
NPI:1043231574
Name:EVANS, ED NELVYN LEZETTE (MD)
Entity type:Individual
Prefix:MS
First Name:ED NELVYN
Middle Name:LEZETTE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1735 VAN CORTLAND TER
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6234
Mailing Address - Country:US
Mailing Address - Phone:201-342-4536
Mailing Address - Fax:201-342-7962
Practice Address - Street 1:385 PROSPECT AVE
Practice Address - Street 2:BERGEN CBOC-DVA
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2570
Practice Address - Country:US
Practice Address - Phone:201-342-4536
Practice Address - Fax:201-342-7962
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine