Healthcare Provider Details

I. General information

NPI: 1134716228
Provider Name (Legal Business Name): AUGUSTINE CAOILE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 WYCKOFF AVE
WYCKOFF NJ
07481-1430
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5002
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-0411
  • Fax: 201-891-0433
Mailing address:
  • Phone: 631-359-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01975900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: