Healthcare Provider Details

I. General information

NPI: 1255968178
Provider Name (Legal Business Name): PRECIOUS OKUNBOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NEW HAVEN AVE STE 101
MILFORD CT
06460-3398
US

IV. Provider business mailing address

1 NEW HAVEN AVE STE 101
MILFORD CT
06460-3398
US

V. Phone/Fax

Practice location:
  • Phone: 203-877-5634
  • Fax:
Mailing address:
  • Phone: 203-877-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number79456
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: