Healthcare Provider Details

I. General information

NPI: 1215517875
Provider Name (Legal Business Name): DR. RACHAEL TIKUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL OKWEN

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TALMADGE RD
EDISON NJ
08817-2860
US

IV. Provider business mailing address

28 JOHNSON RD
WEST ORANGE NJ
07052-3556
US

V. Phone/Fax

Practice location:
  • Phone: 732-800-4060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01124200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: