Provider Demographics
NPI:1598849804
Name:ALBA, AUGUSTA (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTA
Middle Name:
Last Name:ALBA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:AUGUSTA ALBA C/O COLER-GOLDWATER
Mailing Address - Street 2:ONE MAIN STREET
Mailing Address - City:ROOSEVELT ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10044
Mailing Address - Country:US
Mailing Address - Phone:212-318-4242
Mailing Address - Fax:212-318-4874
Practice Address - Street 1:AUGUSTA ALBA C/O COLER-GOLDWATER
Practice Address - Street 2:ONE MAIN STREET
Practice Address - City:ROOSEVELT ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10044
Practice Address - Country:US
Practice Address - Phone:212-318-4242
Practice Address - Fax:212-318-4874
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NY07363401208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07363401OtherNYS MEDICAL LICENSE
NYAA0759932OtherNYS DEA
NYA61629Medicare UPIN