Healthcare Provider Details

I. General information

NPI: 1396874525
Provider Name (Legal Business Name): ALLA BOOHOFF D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CENTRAL AVE SUITE A
CEDARHURST NY
11516-2301
US

IV. Provider business mailing address

76 CONKLIN AVE
WOODMERE NY
11598-1342
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-1924
  • Fax: 516-295-9345
Mailing address:
  • Phone: 516-295-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number223039
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: