Provider Demographics
NPI:1316007891
Name:AUSTIN, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:AUSTIN
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 1:2470 RIVERFRONT CENTER
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4612
Mailing Address - Country:US
Mailing Address - Phone:518-842-7732
Mailing Address - Fax:518-842-2333
Practice Address - Street 1:2470 RIVERFRONT CENTER
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4612
Practice Address - Country:US
Practice Address - Phone:518-842-7732
Practice Address - Fax:518-842-2333
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1472821207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00405339001OtherBLUE SHIELD
NY00700129Medicaid
B82292Medicare UPIN
39002BMedicare ID - Type Unspecified