Healthcare Provider Details

I. General information

NPI: 1275822058
Provider Name (Legal Business Name): AUGUSTIN PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 N MAIN ST
SPRING VALLEY NY
10977-3702
US

IV. Provider business mailing address

263 N MAIN ST
SPRING VALLEY NY
10977-3702
US

V. Phone/Fax

Practice location:
  • Phone: 845-425-9600
  • Fax:
Mailing address:
  • Phone: 845-425-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LUBIN AUGUSTIN
Title or Position: ORIGINAL MEMBER
Credential: MD
Phone: 845-425-9600