Provider Demographics
NPI:1871176487
Name:TAWIAH AGGOR, PRINCE E (RN)
Entity type:Individual
Prefix:
First Name:PRINCE
Middle Name:E
Last Name:TAWIAH AGGOR
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 1:85 BURWOOD AVE # 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7702
Mailing Address - Country:US
Mailing Address - Phone:702-573-7158
Mailing Address - Fax:
Practice Address - Street 1:405 OLMSTEAD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1603
Practice Address - Country:US
Practice Address - Phone:702-573-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY811437163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice