Provider Demographics
NPI:1891433728
Name:PE NANGOH LLC
Entity type:Organization
Organization Name:PE NANGOH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:NANGOH
Authorized Official - Last Name:ELANGWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-251-3017
Mailing Address - Street 1:1109 ONIX ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0285
Mailing Address - Country:US
Mailing Address - Phone:908-251-3017
Mailing Address - Fax:
Practice Address - Street 1:4801 FREDERICKSBURG RD STE A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3667
Practice Address - Country:US
Practice Address - Phone:908-251-3017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty