Healthcare Provider Details

I. General information

NPI: 1306815618
Provider Name (Legal Business Name): FREDERICK OKOYE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 BROAD ST
CLIFTON NJ
07013-1615
US

IV. Provider business mailing address

PO BOX 428
STANHOPE NJ
07874-0428
US

V. Phone/Fax

Practice location:
  • Phone: 973-249-1855
  • Fax: 973-249-1856
Mailing address:
  • Phone: 973-249-1855
  • Fax: 973-249-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMA63691
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: