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General NPI Number Information
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NPI Number | 1992398531
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Entity Type | Individual
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Provider Name | OSAHON AGUEBOR R.T.(R)(MR)(ARRT)
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Gender | Male
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Dates
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Enumeration Date | 02/15/2021
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 3412 BLUESTONE LN
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-8116
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Country | US
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Telephone | 201-952-6420
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Fax |
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Provider Business Mailing Address
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Address Line | 3412 BLUESTONE LN
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-8116
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Country | US
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Telephone | 201-952-6420
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Fax |
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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 | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 641056
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 363102
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License Number State | NY
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