Provider Demographics
NPI:1487274288
Name:EVERAGE, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:EVERAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PASSAIC AVE # 201
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1105
Mailing Address - Country:US
Mailing Address - Phone:484-716-2986
Mailing Address - Fax:
Practice Address - Street 1:129 PASSAIC AVE # 201
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1105
Practice Address - Country:US
Practice Address - Phone:484-716-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist