Provider Demographics
NPI:1841953460
Name:BOACHIE, KWAME PANIN
Entity type:Individual
Prefix:
First Name:KWAME
Middle Name:PANIN
Last Name:BOACHIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108-136 MLK JR BLVD # B1312
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-5348
Mailing Address - Country:US
Mailing Address - Phone:862-291-3267
Mailing Address - Fax:
Practice Address - Street 1:6136 170TH ST APT M4
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1957
Practice Address - Country:US
Practice Address - Phone:347-709-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP11540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine