Provider Demographics
NPI:1346786027
Name:ANKOMAH, GODFRED
Entity Type:Individual
Prefix:
First Name:GODFRED
Middle Name:
Last Name:ANKOMAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 VAN CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3107
Mailing Address - Country:US
Mailing Address - Phone:631-336-6585
Mailing Address - Fax:
Practice Address - Street 1:53 VAN CEDAR ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3107
Practice Address - Country:US
Practice Address - Phone:631-336-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720813163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse