Healthcare Provider Details

I. General information

NPI: 1821553116
Provider Name (Legal Business Name): ERNEST YEBOAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 VENUS RD
SOUTH AMBOY NJ
08879-2423
US

IV. Provider business mailing address

4 VENUS RD
SOUTH AMBOY NJ
08879-2423
US

V. Phone/Fax

Practice location:
  • Phone: 732-322-7243
  • Fax:
Mailing address:
  • Phone: 732-322-7243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: