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NPI Code Detail

MEDICARE: MACULA AUGUSTIN

MEDICARE: MACULA AUGUSTIN
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
1164W00000XLicensed Practical Nurse179796-1NY

General Provider Information

NPI Number : 1588986392
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACULA AUGUSTIN
Provider Business Mailing Address
First Line : 22121 JAMAICA AVE
Second Line :
City : QUEENS VILLAGE
State : NY
Zip : 11428-2015
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 22121 JAMAICA AVE
Second Line :
City : QUEENS VILLAGE
State : NY
Zip : 11428-2015
Country : US
Telephone Number : 718-468-6923
Fax Number : 718-468-6925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2010
Last Update Date : 02/20/2010

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Directions to “ MACULA AUGUSTIN ” Practice Location

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