Provider Demographics
NPI:1306037247
Name:ERIE T AGUSTIN MD PC
Entity Type:Organization
Organization Name:ERIE T AGUSTIN MD PC
Other - Org Name:ERIE T AGUSTIN MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:AGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-205-0030
Mailing Address - Street 1:5801 WOODSIDE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3437
Mailing Address - Country:US
Mailing Address - Phone:718-205-0030
Mailing Address - Fax:718-205-6136
Practice Address - Street 1:5801 WOODSIDE AVE STE 2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3437
Practice Address - Country:US
Practice Address - Phone:718-205-0030
Practice Address - Fax:806-552-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06904GMedicare PIN
NY06904Medicare PIN