Provider Demographics
NPI:1386242626
Name:BOAHEN, EBENEZER
Entity type:Individual
Prefix:
First Name:EBENEZER
Middle Name:
Last Name:BOAHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MARSHALL ST APT 4H
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-8604
Mailing Address - Country:US
Mailing Address - Phone:862-300-8965
Mailing Address - Fax:
Practice Address - Street 1:16 MARSHALL ST APT 4H
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-8604
Practice Address - Country:US
Practice Address - Phone:862-300-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY744665163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse