Healthcare Provider Details

I. General information

NPI: 1982347712
Provider Name (Legal Business Name): EMEKA ALBERT OKONKWO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 E 233RD ST
BRONX NY
10466-3172
US

IV. Provider business mailing address

218 UNION AVE
MOUNT VERNON NY
10550-3605
US

V. Phone/Fax

Practice location:
  • Phone: 347-843-0444
  • Fax:
Mailing address:
  • Phone: 240-217-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number778220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: