Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | F308264-1 | NY |
NPI | 1124503669 |
---|---|
Provider Name | Boahen Owusu Kwakye |
First Address | Bronx, NY 10475-2248 |
Second Address | New Hyde Park, NY 11042-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2018 |
Last Update Date | 31/10/2019 |