Provider Demographics
NPI:1053936344
Name:RIDGEWOOD PHYSICIANS, PLLC
Entity type:Organization
Organization Name:RIDGEWOOD PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMALDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:689-253-2379
Mailing Address - Street 1:2725 NORTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7910
Mailing Address - Country:US
Mailing Address - Phone:689-253-2379
Mailing Address - Fax:731-660-2121
Practice Address - Street 1:2725 NORTHAMPTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7910
Practice Address - Country:US
Practice Address - Phone:689-253-2379
Practice Address - Fax:731-660-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty