Provider Demographics
NPI:1669501227
Name:AUGUSTUS DUNSEITH COLEY
Entity Type:Organization
Organization Name:AUGUSTUS DUNSEITH COLEY
Other - Org Name:AUGUSTUS DUNSEITH COLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTUS
Authorized Official - Middle Name:DUNSEITH
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:INTERNAL MEDICINE
Authorized Official - Phone:718-774-6758
Mailing Address - Street 1:1416 LINCOLN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4038
Mailing Address - Country:US
Mailing Address - Phone:718-774-6788
Mailing Address - Fax:718-778-4980
Practice Address - Street 1:1416 LINCOLN PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4038
Practice Address - Country:US
Practice Address - Phone:718-774-6788
Practice Address - Fax:718-778-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121097261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD47324Medicare UPIN