Provider Demographics
NPI:1154413029
Name:BOAMAH, KWAKU OSAFO-MENSAH (MD)
Entity type:Individual
Prefix:
First Name:KWAKU
Middle Name:OSAFO-MENSAH
Last Name:BOAMAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2117
Mailing Address - Country:US
Mailing Address - Phone:201-333-8800
Mailing Address - Fax:201-333-8585
Practice Address - Street 1:1921 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2117
Practice Address - Country:US
Practice Address - Phone:201-333-8800
Practice Address - Fax:201-333-8585
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64482207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7901003Medicaid
NJ029285Medicare ID - Type Unspecified
G43580Medicare UPIN