=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821112327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCTAVIAN G AUSTRIACU DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 10/02/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 STRAIGHT PATH
-----------------------------------------------------
City | WEST BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11704-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-957-0066
-----------------------------------------------------
Fax | 631-957-2701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 STRAIGHT PATH
-----------------------------------------------------
City | WEST BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11704-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-957-0066
-----------------------------------------------------
Fax | 631-957-2701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. OCTAVIAN GHEORGHE AUSTRIACU
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 631-957-0066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2248091
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------