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General NPI Number Information
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NPI Number | 1801985197
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Entity Type | Individual
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Provider Name | CLEMENT E TAGOE MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | MMC - DEPT. OF MEDICINE 3400 BAINBRIDGE AVENUE
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City | BRONX
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State | NY
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Zip | 10467
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Country | US
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Telephone | 718-920-7762
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Fax | 718-231-0293
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Provider Business Mailing Address
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Address Line | 6710C 190TH LN APT. 3C
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-3730
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Country | US
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Telephone | 718-920-7762
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Fax | 718-515-6103
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 230072
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License Number State | NY
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