Healthcare Provider Details

I. General information

NPI: 1922897602
Provider Name (Legal Business Name): DARYL J AUGUSTINE DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 3RD AVE STE 201
BRONX NY
10455-4066
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 718-401-3668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DARYL AUGUSTINE
Title or Position: OWNER
Credential: DPM
Phone: 516-510-6741