Provider Demographics
NPI:1063402311
Name:AB MEDICAL CARE PLLC
Entity type:Organization
Organization Name:AB MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:516-295-1924
Mailing Address - Street 1:650 CENTRAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2301
Mailing Address - Country:US
Mailing Address - Phone:516-295-1924
Mailing Address - Fax:516-295-9345
Practice Address - Street 1:650 CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2301
Practice Address - Country:US
Practice Address - Phone:516-295-1924
Practice Address - Fax:516-295-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223039207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02228137Medicaid
NY02228137Medicaid
NYH59676Medicare UPIN