Healthcare Provider Details

I. General information

NPI: 1174615165
Provider Name (Legal Business Name): JACKSON A OKOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 UNION AVE SUITE 204
IRVINGTON NJ
07111-3277
US

IV. Provider business mailing address

1 ASTOR PL
AVENEL NJ
07001-1460
US

V. Phone/Fax

Practice location:
  • Phone: 973-416-6981
  • Fax: 973-375-5766
Mailing address:
  • Phone: 973-416-6981
  • Fax: 973-375-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMA52181
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: