Provider Demographics
NPI:1811043003
Name:AUGOUSTINIATOS, EVANGELIA LILA (MD)
Entity Type:Individual
Prefix:DR
First Name:EVANGELIA
Middle Name:LILA
Last Name:AUGOUSTINIATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 TERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3811
Mailing Address - Country:US
Mailing Address - Phone:631-979-7400
Mailing Address - Fax:631-979-7440
Practice Address - Street 1:100 TERRY ROAD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3811
Practice Address - Country:US
Practice Address - Phone:631-979-7400
Practice Address - Fax:631-979-7440
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14G711Medicare ID - Type Unspecified
NYF27844Medicare UPIN