Healthcare Provider Details

I. General information

NPI: 1063402311
Provider Name (Legal Business Name): AB MEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
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

650 CENTRAL AVE SUITE A
CEDARHURST NY
11516-2301
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number223039
License Number StateNY

VIII. Authorized Official

Name: DR. ALLA BOOHOFF
Title or Position: PRESIDENT
Credential: M.D., D.O.
Phone: 516-295-1924