Provider Demographics
NPI:1336240795
Name:BENTSI-BARNES, AUGUSTUS (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTUS
Middle Name:
Last Name:BENTSI-BARNES
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 1:368 BROADWAY STE 105
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5160
Mailing Address - Country:US
Mailing Address - Phone:845-334-8635
Mailing Address - Fax:845-334-8637
Practice Address - Street 1:368 BROADWAY STE 105
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5160
Practice Address - Country:US
Practice Address - Phone:845-334-8635
Practice Address - Fax:845-334-8637
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01498026Medicaid
NY50J071Medicare ID - Type Unspecified
NY01498026Medicaid