Provider Demographics
NPI:1275720906
Name:AUGUSTINE, JESSY
Entity Type:Individual
Prefix:
First Name:JESSY
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PENN PLAZA
Mailing Address - Street 2:EVERCARE - UNITED HEALTHCARE, 7TH FL. STE. 725
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119
Mailing Address - Country:US
Mailing Address - Phone:212-216-6568
Mailing Address - Fax:212-216-6606
Practice Address - Street 1:1 PENN PLAZA
Practice Address - Street 2:EVERCARE - UNITED HEALTHCARE , 7TH FL. STE. 725
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119
Practice Address - Country:US
Practice Address - Phone:212-216-6568
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304680364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health