Provider Demographics
NPI:1629436191
Name:OBIRI-YEBOAH, EUGENE O
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:O
Last Name:OBIRI-YEBOAH
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 1:32 CARNWATH CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-1941
Mailing Address - Country:US
Mailing Address - Phone:718-496-5778
Mailing Address - Fax:
Practice Address - Street 1:32 CARNWATH CT
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-1941
Practice Address - Country:US
Practice Address - Phone:718-496-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program