Healthcare Provider Details

I. General information

NPI: 1710508585
Provider Name (Legal Business Name): TOXICITY ASSESSORS GLOBAL OF PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 5TH ST APT 505
SANTA MONICA CA
90401-4421
US

IV. Provider business mailing address

1430 5TH ST APT 505
SANTA MONICA CA
90401-4421
US

V. Phone/Fax

Practice location:
  • Phone: 215-779-0805
  • Fax:
Mailing address:
  • Phone: 215-779-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DR. AUGUSTINE AGYEKUM
Title or Position: MEDICAL DIRECTOR
Credential: PHD TOXICOLOGY
Phone: 215-779-0805