Provider Demographics
NPI:1639140858
Name:AUTERI, PAUL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:AUTERI
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 1:1694 64TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2715
Mailing Address - Country:US
Mailing Address - Phone:718-232-4990
Mailing Address - Fax:718-259-1751
Practice Address - Street 1:1694 64TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2715
Practice Address - Country:US
Practice Address - Phone:718-232-4990
Practice Address - Fax:718-259-1751
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01721860Medicaid
NY01721860Medicaid
B13143Medicare UPIN