Provider Demographics
NPI:1124737093
Name:DKA MEDICAL LLC
Entity type:Organization
Organization Name:DKA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:973-641-0353
Mailing Address - Street 1:4 WALNUT TER
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3063
Mailing Address - Country:US
Mailing Address - Phone:973-641-0353
Mailing Address - Fax:973-857-1240
Practice Address - Street 1:4 WALNUT TER
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3063
Practice Address - Country:US
Practice Address - Phone:973-641-0353
Practice Address - Fax:973-857-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty