Provider Demographics
NPI:1730290354
Name:AUGUSTE, JEAN K (MD,)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:K
Last Name:AUGUSTE
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-5015
Mailing Address - Country:US
Mailing Address - Phone:718-802-1111
Mailing Address - Fax:
Practice Address - Street 1:134 VAN DYKE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-1012
Practice Address - Country:US
Practice Address - Phone:718-802-1111
Practice Address - Fax:718-802-9013
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY153918Medicaid
NY153918Medicaid
NY63399Medicare UPIN