Provider Demographics
NPI:1497516041
Name:CONSTANCE AKOSUA AMOAKO-ABABIO
Entity Type:Organization
Organization Name:CONSTANCE AKOSUA AMOAKO-ABABIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKOSUA
Authorized Official - Middle Name:CONSTANCE
Authorized Official - Last Name:ABABIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-745-5031
Mailing Address - Street 1:100 MATAWAN RD STE 325
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MATAWAN RD STE 325
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3911
Practice Address - Country:US
Practice Address - Phone:631-745-5031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty