Provider Demographics
NPI:1750768925
Name:BOADU, ENOCK K (RN)
Entity type:Individual
Prefix:
First Name:ENOCK
Middle Name:K
Last Name:BOADU
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 1:875 BOYNTON AVE
Mailing Address - Street 2:#16G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4750
Mailing Address - Country:US
Mailing Address - Phone:646-546-8060
Mailing Address - Fax:
Practice Address - Street 1:875 BOYNTON AVE
Practice Address - Street 2:#16G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4750
Practice Address - Country:US
Practice Address - Phone:646-546-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY698871163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse