Individual
OSAYOMWANBO AGHATISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 E 125TH ST, NEW YORK, NY 10035-6000
(646) 672-6800
Mailing address
4128 BAYCHESTER AVE, BRONX, NY 10466-2122
(718) 450-5900
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
5972541
NY
Other
Enumeration date
01/03/2020
Last updated
01/03/2020
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