Healthcare Provider Details

I. General information

NPI: 1174871602
Provider Name (Legal Business Name): FAITH CYNTHIA OKOBI SERVICE COORDINATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21426 41ST AVE STE BAYSIDE SUITE 130
BAYSIDE NY
11361-2159
US

IV. Provider business mailing address

16809 110TH AVE
JAMAICA NY
11433-3463
US

V. Phone/Fax

Practice location:
  • Phone: 718-631-1110
  • Fax: 718-631-1314
Mailing address:
  • Phone: 917-627-6009
  • Fax: 718-523-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: