Provider Demographics
NPI:1962574418
Name:AKUOKU, SAMUEL BOATENG (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BOATENG
Last Name:AKUOKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8 TATEM WAY
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1716
Mailing Address - Country:US
Mailing Address - Phone:718-344-8207
Mailing Address - Fax:718-949-0331
Practice Address - Street 1:22414 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2023
Practice Address - Country:US
Practice Address - Phone:718-949-6433
Practice Address - Fax:718-949-0331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY178587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01155251Medicaid
E20331Medicare UPIN