Provider Demographics
NPI:1164879037
Name:AUGUSTINE, DARYL (DPM)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 JUNARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3131
Mailing Address - Country:US
Mailing Address - Phone:516-510-6741
Mailing Address - Fax:
Practice Address - Street 1:3626 E TREMONT AVE STE 102
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2030
Practice Address - Country:US
Practice Address - Phone:718-409-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006998213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery