Provider Demographics
NPI:1700949823
Name:AUSTRIACU, OCTAVIAN G (DO)
Entity type:Individual
Prefix:DR
First Name:OCTAVIAN
Middle Name:G
Last Name:AUSTRIACU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:170 LITTLE EAST NECK RD.
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:631-526-9575
Mailing Address - Fax:631-526-9202
Practice Address - Street 1:2 YATES LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1419
Practice Address - Country:US
Practice Address - Phone:516-547-1220
Practice Address - Fax:631-526-9202
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2248091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90689Medicare UPIN
H90689Medicare UPIN