Provider Demographics
NPI:1184838831
Name:AUGUSTIN, PAUL RALPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RALPH
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3057 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3040
Mailing Address - Country:US
Mailing Address - Phone:347-414-0355
Mailing Address - Fax:
Practice Address - Street 1:163 WEST 125TH STREET
Practice Address - Street 2:MPC 125TH STREET CLINIC,
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-866-2751
Practice Address - Fax:212-866-2760
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57010945207Q00000X
NY249267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine