MEDICARE: JEAN M DAUGUSTINE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	191222	NY
2	207RH0003X	Hematology & Oncology Physician	191222	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295787042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN M DAUGUSTINE MD

Provider Business Mailing Address
First Line	:	1530 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4117
Country	:	US
Telephone Number	:	718-484-8818
Fax Number	:	732-440-1483

Provider Business Practice Location Address
First Line	:	1530 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4117
Country	:	US
Telephone Number	:	718-484-8818
Fax Number	:	732-440-1483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	09/13/2021

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