EVERGRIN LLC (NPI# 1720495195) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720495195 |
| Entity Type | Organization |
| Organization Name | EVERGRIN LLC |
| Practice Address |
2416 S Broad St Philadelphia PA 19145-4418 |
| Mailing Address |
320 N Oxford Valley Rd Fairless Hills PA 19030-2610 |
| Practice Telephone | 2679812652 |
| Mailing Telephone | 2159469400 |
| Mailing Fax Number | 2159469409 |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2014-07-17 |
| Authorized Official Name | MS. PRIYA TRIVEDI (PARTNER/DIRECTOR) |
| Authorized Official Telephone | 2679812652 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DS038095 | PA | Dental Providers |
| Street Address |
2416 S BROAD ST |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19145-4418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053467324 | Christopher James Cox | Dentist | 2416 S Broad St, Philadelphia, PA 19145-4418 | 2007-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518564350 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 2300a Rear W Oregon Ave, Philadelphia, PA 19145 | 2020-10-05 |
| 1376069559 | Kyle James Hughes | Physical Therapist | 2192 W Oregon Ave Fl 3, Philadelphia, PA 19145 | 2017-08-18 |
| 1821519752 | John A Takacs Dmd | Clinic/Center | 1707w Passyunk Ave, Philadelphia, PA 19145 | 2017-06-30 |
| 1033573209 | Kenneth Donahue | Dentist | 1517 Packer Avenue, Philadelphia, PA 19145 | 2016-04-13 |
| 1437516895 | Kimberly Wyand | Physical Therapist | 2129 Oregon St, Philadelphia, PA 19145 | 2016-01-15 |
| 1760856538 | Liji Vipin | Nurse Practitioner | 1615 Oregon Ave, Philadelphia, PA 19145 | 2015-11-17 |
| 1528333846 | Gina Marie Doyle | Registered Nurse | 1930 S. Broad Street, Philadelphia, PA 19145 | 2012-03-20 |
| 1639446214 | Thao T Tran | Pharmacist | 2014-24 South Broad St, Philadelphia, PA 19145 | 2011-11-25 |
| 1649573171 | Phyllis Yang | Internal Medicine | 1700 S Broad St, Unit 201, Philadelphia, PA 19145 | 2010-12-05 |
| 1326364613 | South Philadelphia Open Mri, LLC | Clinic/Center | 1834 West Oregon Avenue, Philadelphia, PA 19145 | 2010-04-13 |
| Find all providers in zip 19145 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385581 | Samir Zahedpasha | Dentist | 1933 Delancey Pl, Philadelphia, PA 19103-6611 | 2020-10-29 |
| 1164040424 | Aledy Miguelina Moreta | Dentist | 1813 Vineyard St, Philadelphia, PA 19130-2122 | 2020-07-13 |
| 1033737473 | David Agia | Dentist | 1318 Franklin Mills Cir # 807, Philadelphia, PA 19154-3130 | 2020-07-13 |
| 1710504113 | Hanna Lee | Dentist | 1616 S Rosewood St, Philadelphia, PA 19145-1519 | 2020-07-01 |
| 1982221636 | Aldo Profka | Dentist | 8001 Roosevelt Blvd Ste 304, Philadelphia, PA 19152-3039 | 2020-06-29 |
| 1558985317 | Oxford Dental LLC | Dentist | 5233 Oxford Ave, Philadelphia, PA 19124-1803 | 2020-06-07 |
| 1487277935 | Issam Ghaben | Dentist | 4210 Sansom St, Philadelphia, PA 19104-3589 | 2020-05-19 |
| 1508490509 | Mount Airy Family Dental LLC | Dentist | 1600 Ivy Hill Rd, Philadelphia, PA 19150-1008 | 2020-02-27 |
| 1801436506 | Special Outreach Services, PC | Dentist | 2301 E Allegheny Ave Ste 202, Philadelphia, PA 19134-4427 | 2020-01-10 |
| 1720624547 | Philadelphia Mills Dental Center | Dentist | 1318 Franklin Mills Cir #807, Philadelphia, PA 19154 | 2019-11-27 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19145 |
Please comment or provide details below to improve the information on EVERGRIN LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.