Healthcare Provider Details

I. General information

NPI: 1245539949
Provider Name (Legal Business Name): MR. AUSTIN EPSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SEGUINE AVE APT 1
STATEN ISLAND NY
10309-3712
US

IV. Provider business mailing address

305 SEGUINE AVE APT 1
STATEN ISLAND NY
10309-3712
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-8300
  • Fax:
Mailing address:
  • Phone: 718-967-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number007004
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: