Healthcare Provider Details

I. General information

NPI: 1205687050
Provider Name (Legal Business Name): KOFI BOAKYE OPOKU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NEW BRUNSWICK AVE
PERTH AMBOY NJ
08861-3654
US

IV. Provider business mailing address

625 S ELLIOTT RD APT 327
CHAPEL HILL NC
27517-2630
US

V. Phone/Fax

Practice location:
  • Phone: 732-324-5080
  • Fax: 732-324-4669
Mailing address:
  • Phone: 681-361-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: