Provider Demographics
NPI:1558499251
Name:COLON, AGUSTIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:A
Last Name:COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:158 W 27TH ST
Mailing Address - Street 2:11TH FLOOR SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6216
Mailing Address - Country:US
Mailing Address - Phone:212-563-2627
Mailing Address - Fax:212-563-0605
Practice Address - Street 1:571 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5104
Practice Address - Country:US
Practice Address - Phone:212-563-2627
Practice Address - Fax:212-563-0605
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105421208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02533035Medicaid
NYH52832Medicare UPIN
NY02533035Medicaid