Basic Information
| Provider Information | |||||||||
| NPI: | 1629373394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOATENG | ||||||||
| FirstName: | CHARITY | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3858 3RD AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104578241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186712100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3858 3RD AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104578241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186712100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2011 | ||||||||
| LastUpdateDate: | 01/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 629052 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.