Provider Demographics
NPI:1467555458
Name:AGBONKPOLO, FRANCIS O (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:O
Last Name:AGBONKPOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3220
Mailing Address - Country:US
Mailing Address - Phone:914-530-2323
Mailing Address - Fax:914-530-2320
Practice Address - Street 1:140 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2515
Practice Address - Country:US
Practice Address - Phone:914-530-2323
Practice Address - Fax:914-530-2320
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY193784OtherNY STATE LICENSE