Provider Demographics
NPI:1922156132
Name:E.LILA AUGOUSTINIATOS, MD, PC
Entity Type:Organization
Organization Name:E.LILA AUGOUSTINIATOS, MD, PC
Other - Org Name:EVIA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANGELIA
Authorized Official - Middle Name:LILA
Authorized Official - Last Name:AUGOUSTINIATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-979-7400
Mailing Address - Street 1:100 TERRY RD
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEN131Medicare ID - Type Unspecified
NYF27844Medicare UPIN