Provider Demographics
NPI:1356989693
Name:AAG NP SERVICES LLC
Entity type:Organization
Organization Name:AAG NP SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIRIO
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-490-4293
Mailing Address - Street 1:309 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6207
Mailing Address - Country:US
Mailing Address - Phone:718-490-4293
Mailing Address - Fax:
Practice Address - Street 1:309 CORNELL DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33460-6207
Practice Address - Country:US
Practice Address - Phone:718-490-4293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246153Medicaid