Provider Demographics
NPI:1609892645
Name:AUSTEN, BURTON G (MD)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:G
Last Name:AUSTEN
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 1:30 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1326
Mailing Address - Country:US
Mailing Address - Phone:203-397-2181
Mailing Address - Fax:203-389-9896
Practice Address - Street 1:75 NEW HAVEN AVENUE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4854
Practice Address - Country:US
Practice Address - Phone:212-614-1011
Practice Address - Fax:203-389-9896
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0245992084P0800X
NY1517582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1245994Medicaid
NY15G311OtherMEDICARE
NY15G311OtherMEDICARE
B27005Medicare UPIN