Provider Demographics
NPI:1821044090
Name:AIGBOGUN, STEVEN (RPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:AIGBOGUN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE DR
Mailing Address - Street 2:PO BOX 874
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1939
Mailing Address - Country:US
Mailing Address - Phone:609-463-9553
Mailing Address - Fax:609-463-9540
Practice Address - Street 1:1 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1939
Practice Address - Country:US
Practice Address - Phone:609-463-9553
Practice Address - Fax:609-463-9540
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00466300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223305571OtherCIGNA
NJ650010941OtherRAILROAD MEDICARE PIN
NJ1347424OtherUNITED HEALTHCARE
NJ223305571OtherTRICARE / CHAMPUS GROUP #
NJ1602579OtherAMERIHEALTH PPO
NJP853305OtherOXFORD
NJ0822480001OtherDMERC A
NJ2281152000OtherAMERIHEALTH HMO
NJDD2634OtherRAILROAD MEDICARE GROUP #
NJ223305571OtherAETNA
NJ223305571OtherHORIZON BLUE SHIELD GRP #
NJ223305571OtherHORIZON MERCY HP GROUP #
NJ58001OtherCIGNA
NJ1602584OtherAMERIHEALTH HMO GROUP #
NJ2K3845OtherHEALTHNET
NJ223305571OtherCIGNA
NJ223305571OtherAETNA