Healthcare Provider Details

I. General information

NPI: 1811087570
Provider Name (Legal Business Name): WILLIAM O BOAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E 18TH ST
BROOKLYN NY
11226-4362
US

IV. Provider business mailing address

145 E 18TH ST
BROOKLYN NY
11226-4362
US

V. Phone/Fax

Practice location:
  • Phone: 718-282-9690
  • Fax: 718-287-5915
Mailing address:
  • Phone: 718-282-9690
  • Fax: 718-287-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number130416
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: