Provider Demographics
NPI:1174576417
Name:PAIUSCO, AUGUSTO D (MD)
Entity type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:D
Last Name:PAIUSCO
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:PO BOX 10088
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-0088
Mailing Address - Country:US
Mailing Address - Phone:718-988-2323
Mailing Address - Fax:718-998-7660
Practice Address - Street 1:3131 KINGS HWY
Practice Address - Street 2:STE B-1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:718-998-2323
Practice Address - Fax:718-998-7660
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168015207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01551606Medicaid
NY01551606Medicaid
NY35L141Medicare PIN