Provider Demographics
NPI:1821112327
Name:OCTAVIAN G AUSTRIACU DO PC
Entity Type:Organization
Organization Name:OCTAVIAN G AUSTRIACU DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIAN
Authorized Official - Middle Name:GHEORGHE
Authorized Official - Last Name:AUSTRIACU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-957-0066
Mailing Address - Street 1:900 STRAIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3203
Mailing Address - Country:US
Mailing Address - Phone:631-957-0066
Mailing Address - Fax:631-957-2701
Practice Address - Street 1:900 STRAIGHT PATH
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-3203
Practice Address - Country:US
Practice Address - Phone:631-957-0066
Practice Address - Fax:631-957-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2248091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02877609Medicaid
NY1821112327OtherPC NPI
NY1700949823OtherINDIVIDUAL NPI
NY1700949823OtherINDIVIDUAL NPI
NYH90689Medicare UPIN
NYOA0WWT1410Medicare PIN