Individual provider Active NPI

Boima Sarnor Gobah II, FNP

  • Family Nurse Practitioner
  • Trenton, NJ
National Provider Identifier
1720740731
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ01184800 Issued in NJ
Practice address
626 New Willow St
Trenton, NJ 08618-3740
Phone
(609) 540-7737
NPI assigned
Oct 6, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26NJ01184800 NJ Primary

Addresses

Primary practice location

626 New Willow St
Trenton, NJ 08618-3740

Mailing address

626 New Willow St
Trenton, NJ 08618-3740
Phone (609) 540-7377

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220225001562 NJ Practitioner - Nurse Practitioner 7911391487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of New Jersey Omb Centralized PayrollGroup PAC ID 6406742592, 129 clinicians

Practice addresses (Care Compare)

1676 E Landis Ave
Vineland, NJ 08361-2943
Phone (856) 696-6000

Hospital & facility affiliations

  • Inspira Medical Center Mullica Hill Hospital, Elmer, NJ, CCN 310069
  • Inspira Medical Center Vineland Hospital, Vineland, NJ, CCN 310032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ01184800NJMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
State of New Jersey Omb Centralized Payroll CurrentSince Jun 4, 2022 Accepting new patients
State of New Jersey Omb Centralized Payroll CurrentSince Jun 4, 2022 Accepting new patients

Locations

1676 E Landis Ave
Vineland, NJ 08361
Phone (856) 696-6000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1720740731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 NEW WILLOW ST",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086183740",
            "telephone_number": "609-540-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 NEW WILLOW ST",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086183740",
            "telephone_number": "609-540-7737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOBAH",
        "first_name": "BOIMA",
        "middle_name": "SARNOR",
        "name_suffix": "II",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ01184800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trenton, NJ

Sources for this page

Verify at the official NPI Registry.