Provider Demographics
NPI:1396874525
Name:BOOHOFF, ALLA (DO)
Entity type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:BOOHOFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CONKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1342
Mailing Address - Country:US
Mailing Address - Phone:516-295-1924
Mailing Address - Fax:
Practice Address - Street 1:650 CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2301
Practice Address - Country:US
Practice Address - Phone:516-295-1924
Practice Address - Fax:516-295-9345
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH59676Medicare UPIN
NY5026B1Medicare ID - Type UnspecifiedPERSONAL PROVIDER ID