MEDICARE: KWADWO BOAKYE PHYSICIAN, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1952571309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KWADWO BOAKYE PHYSICIAN, PC

Provider Business Mailing Address
First Line	:	1950 MCGRAW AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-7967
Country	:	US
Telephone Number	:	718-892-2390
Fax Number	:	718-892-8090

Provider Business Practice Location Address
First Line	:	1950 MCGRAW AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-7967
Country	:	US
Telephone Number	:	718-892-2390
Fax Number	:	718-892-8090

Authorized Official
Title or Position	:	ATTENDING PHYSICIAN
Name	:	DR. KWADWO BOAKYE
Credential	:	MD
Telephone Number	:	718-892-2390

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	06/16/2008

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