Basic Information
| Provider Information | |||||||||
| NPI: | 1801985197 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAGOE | ||||||||
| FirstName: | CLEMENT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6710C 190TH LN | ||||||||
| Address2: | APT. 3C | ||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113653730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189207762 | ||||||||
| FaxNumber: | 7185156103 | ||||||||
| Practice Location | |||||||||
| Address1: | MMC - DEPT. OF MEDICINE | ||||||||
| Address2: | 3400 BAINBRIDGE AVENUE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189207762 | ||||||||
| FaxNumber: | 7182310293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 10/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 230072 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.