Provider Demographics
NPI:1710632088
Name:AHENKORA, IRENE MARFO
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MARFO
Last Name:AHENKORA
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 1:1479 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2029
Mailing Address - Country:US
Mailing Address - Phone:516-859-1490
Mailing Address - Fax:
Practice Address - Street 1:WOODHULL MEDICAL AND MENTAL HEALTH CENTER
Practice Address - Street 2:760 BROADWAY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-5855
Practice Address - Fax:718-963-5739
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403421-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty