Basic Information
| Provider Information | |||||||||
| NPI: | 1275720906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUGUSTINE | ||||||||
| FirstName: | JESSY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PENN PLAZA | ||||||||
| Address2: | EVERCARE - UNITED HEALTHCARE, 7TH FL. STE. 725 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122166568 | ||||||||
| FaxNumber: | 2122166606 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PENN PLAZA | ||||||||
| Address2: | EVERCARE - UNITED HEALTHCARE , 7TH FL. STE. 725 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122166568 | ||||||||
| FaxNumber: | 2122166606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 09/26/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | 304680 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.