Provider Demographics
NPI:1992398531
Name:AGUEBOR, OSAHON (RT(R)(MR)(ARRT))
Entity Type:Individual
Prefix:
First Name:OSAHON
Middle Name:
Last Name:AGUEBOR
Suffix:
Gender:M
Credentials:RT(R)(MR)(ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 BLUESTONE LN
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8116
Mailing Address - Country:US
Mailing Address - Phone:201-952-6420
Mailing Address - Fax:
Practice Address - Street 1:3412 BLUESTONE LN
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8116
Practice Address - Country:US
Practice Address - Phone:201-952-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ641056247100000X
NY363102247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist