Healthcare Provider Details

I. General information

NPI: 1164879037
Provider Name (Legal Business Name): DARYL AUGUSTINE D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 E TREMONT AVE STE 102
BRONX NY
10465-2030
US

IV. Provider business mailing address

240 E SHORE RD PH 21
GREAT NECK NY
11023-2450
US

V. Phone/Fax

Practice location:
  • Phone: 718-409-0400
  • Fax:
Mailing address:
  • Phone: 516-510-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: