Provider Demographics
NPI:1285942839
Name:AGO, AILEEN HOPE (MD)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:HOPE
Last Name:AGO
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 1:10 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-4293
Mailing Address - Country:US
Mailing Address - Phone:856-825-5932
Mailing Address - Fax:
Practice Address - Street 1:10 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-4293
Practice Address - Country:US
Practice Address - Phone:856-825-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259766-1208000000X
NJ25MA08808700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics