Healthcare Provider Details

I. General information

NPI: 1881700367
Provider Name (Legal Business Name): AUGUSTINE MOSCATELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 3600S
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 BRADHURST AVE STE 3100N
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-7636
  • Fax:
Mailing address:
  • Phone: 914-909-9018
  • Fax: 914-886-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number158364
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number158364
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: