Provider Demographics
NPI:1104055623
Name:AUGUSTIN, STANLEY (RN)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5O BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:516-887-1200
Mailing Address - Fax:516-593-2848
Practice Address - Street 1:5O BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-887-1200
Practice Address - Fax:516-593-2848
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592835-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health