Provider Demographics
NPI:1225103906
Name:DA SILVA, AUGUSTO S (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:S
Last Name:DA SILVA
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 1:3072 E. JERICHO TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-692-0654
Mailing Address - Fax:631-692-0656
Practice Address - Street 1:3072 E. JERICHO TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731
Practice Address - Country:US
Practice Address - Phone:631-692-0654
Practice Address - Fax:631-692-0656
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00267194OtherRAILROAD MEDICARE
NYP00267194OtherRAILROAD MEDICARE
NYH55558Medicare UPIN
NYP00267194OtherRAILROAD MEDICARE