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General NPI Number Information
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NPI Number | 1760576623
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Entity Type | Organization
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Legal Business Name | ENEIDA AGOSTO, MD PC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 3755 72ND ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6144
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Country | US
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Telephone | 718-507-5400
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Fax | 718-507-5422
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Provider Business Mailing Address
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Address Line | 3755 72ND ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6144
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Country | US
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Telephone | 718-507-5400
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Fax | 718-507-5422
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ENEIDA AGOSTO-COLON
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Credential | M.D.
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Telephone | 718-507-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 211512
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License Number State | NY
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