Healthcare Provider Details

I. General information

NPI: 1285918482
Provider Name (Legal Business Name): HONEYLEE DUQUE AGUSTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LYON PL
OGDENSBURG NY
13669-2590
US

IV. Provider business mailing address

400 N MAIN ST
WARSAW NY
14569-1025
US

V. Phone/Fax

Practice location:
  • Phone: 315-713-6770
  • Fax:
Mailing address:
  • Phone: 585-786-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number003924
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: