Provider Demographics
NPI:1720740731
Name:GOBAH, BOIMA SARNOR II (FNP)
Entity Type:Individual
Prefix:
First Name:BOIMA
Middle Name:SARNOR
Last Name:GOBAH
Suffix:II
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 NEW WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-3740
Mailing Address - Country:US
Mailing Address - Phone:609-540-7377
Mailing Address - Fax:
Practice Address - Street 1:626 NEW WILLOW ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3740
Practice Address - Country:US
Practice Address - Phone:609-540-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01184800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily