Provider Demographics
NPI:1336997709
Name:AGHOMON, VICTORY AIMALOHI (MD)
Entity Type:Individual
Prefix:MRS
First Name:VICTORY
Middle Name:AIMALOHI
Last Name:AGHOMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 EAST 49TH STREET
Mailing Address - Street 2:ROOM 4-20
Mailing Address - City:DOWNTOWN BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451
Mailing Address - Country:US
Mailing Address - Phone:718-576-5030
Mailing Address - Fax:718-579-4700
Practice Address - Street 1:234 EAST 49TH STREET
Practice Address - Street 2:ROOM 4-20
Practice Address - City:DOWNTOWN BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-576-5030
Practice Address - Fax:718-579-4700
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program