Provider Demographics
NPI:1275699878
Name:AKALONU, AUGUSTINE T (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:T
Last Name:AKALONU
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 1:653 E 233RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2801
Mailing Address - Country:US
Mailing Address - Phone:718-882-6388
Mailing Address - Fax:718-882-6396
Practice Address - Street 1:653 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2801
Practice Address - Country:US
Practice Address - Phone:718-882-6388
Practice Address - Fax:718-882-6396
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210150208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY210150OtherLIC. #
NY01882993Medicaid