Provider Demographics
NPI:1386944676
Name:EMPIRE FAMILY OPHTHALMOLOGY, PC
Entity type:Organization
Organization Name:EMPIRE FAMILY OPHTHALMOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WISLY
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-531-6100
Mailing Address - Street 1:100 LIVINGSTON STREET SUITE 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5127
Mailing Address - Country:US
Mailing Address - Phone:929-295-6616
Mailing Address - Fax:929-295-6594
Practice Address - Street 1:100 LIVINGSTON STREET SUITE 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5127
Practice Address - Country:US
Practice Address - Phone:929-295-6616
Practice Address - Fax:929-295-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235739261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery