MEDICARE: JACKSON A OKOYA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	MA52181	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174615165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKSON A OKOYA MD

Provider Business Mailing Address
First Line	:	1 ASTOR PL
Second Line	:
City	:	AVENEL
State	:	NJ
Zip	:	07001-1460
Country	:	US
Telephone Number	:	973-416-6981
Fax Number	:	973-375-5766

Provider Business Practice Location Address
First Line	:	40 UNION AVE
Second Line	:	SUITE 204
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-3277
Country	:	US
Telephone Number	:	973-416-6981
Fax Number	:	973-375-5766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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Directions to “ JACKSON A OKOYA MD” Practice Location

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