Healthcare Provider Details

I. General information

NPI: 1417584962
Provider Name (Legal Business Name): CHUKWUNWIKE P OKAFOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 VALLEY ST STE 320
SOUTH ORANGE NJ
07079-2881
US

IV. Provider business mailing address

20 VALLEY ST STE 320
SOUTH ORANGE NJ
07079-2881
US

V. Phone/Fax

Practice location:
  • Phone: 973-313-1113
  • Fax: 973-313-1191
Mailing address:
  • Phone: 973-313-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MA12290720
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: