Provider Demographics
NPI:1205320934
Name:BOAH & BOAH M.D P.C
Entity type:Organization
Organization Name:BOAH & BOAH M.D P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AKUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-282-9690
Mailing Address - Street 1:145 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4362
Mailing Address - Country:US
Mailing Address - Phone:718-282-9690
Mailing Address - Fax:718-287-5915
Practice Address - Street 1:145 E 18TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4362
Practice Address - Country:US
Practice Address - Phone:718-282-9690
Practice Address - Fax:718-287-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000368447Medicaid