Provider Demographics
NPI:1083929822
Name:AMOAH, GRACE C
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:C
Last Name:AMOAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 E 235TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2753
Mailing Address - Country:US
Mailing Address - Phone:718-994-0991
Mailing Address - Fax:719-994-0991
Practice Address - Street 1:680 E 235TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2753
Practice Address - Country:US
Practice Address - Phone:718-994-0991
Practice Address - Fax:719-994-0991
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies