Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 216346 | NY |
NPI | 1548355464 |
---|---|
Provider Name | Dr. Gerrad Augustine |
First Address | Newburgh, NY 12550-7044 |
Second Address | Bronx, NY 10457-7606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |