Provider Demographics
NPI:1376291013
Name:AUGUSTIN, ANDRE (APN)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 A LINN DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044
Mailing Address - Country:US
Mailing Address - Phone:973-641-0353
Mailing Address - Fax:
Practice Address - Street 1:135 BLOOMFIELD AVE STE F
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5902
Practice Address - Country:US
Practice Address - Phone:862-213-0033
Practice Address - Fax:862-213-0037
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01282100251J00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ01282100OtherNP