MEDICARE: ALEX BOAFO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	155125	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083708549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX BOAFO M.D.

Provider Business Mailing Address
First Line	:	600 EAST 233RD STREET
Second Line	:	5TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10466
Country	:	US
Telephone Number	:	718-920-9647
Fax Number	:	718-920-6812

Provider Business Practice Location Address
First Line	:	2115 STARLING AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462
Country	:	US
Telephone Number	:	718-822-2810
Fax Number	:	718-822-8732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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