Provider Demographics
NPI:1669878278
Name:ADJEI - BOATENG, DENNIS (RN)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:ADJEI - BOATENG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5640
Mailing Address - Country:US
Mailing Address - Phone:631-398-8551
Mailing Address - Fax:
Practice Address - Street 1:1417 BROOK AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5640
Practice Address - Country:US
Practice Address - Phone:631-398-8551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693289163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse