Healthcare Provider Details

I. General information

NPI: 1194168955
Provider Name (Legal Business Name): DAVID HENRY AGGEN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 E 68TH ST
NEW YORK NY
10065-5606
US

IV. Provider business mailing address

1101 W UNIVERSITY DR 3 NORTH
ROCHESTER MI
48307-1863
US

V. Phone/Fax

Practice location:
  • Phone: 646-422-4679
  • Fax:
Mailing address:
  • Phone: 217-799-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25MA10610200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number283608
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: