Provider Demographics
NPI:1144312885
Name:GUARENTE, AUGUSTUS (OD)
Entity type:Individual
Prefix:DR
First Name:AUGUSTUS
Middle Name:
Last Name:GUARENTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 LUCAS AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4316
Mailing Address - Country:US
Mailing Address - Phone:845-339-4990
Mailing Address - Fax:845-339-5001
Practice Address - Street 1:240 LUCAS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4316
Practice Address - Country:US
Practice Address - Phone:845-339-4990
Practice Address - Fax:845-339-5001
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV3749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU20076Medicare UPIN
NYC68711Medicare ID - Type Unspecified