Healthcare Provider Details

I. General information

NPI: 1871998062
Provider Name (Legal Business Name): OFIONG OKON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 WESTCHESTER AVE
BRONX NY
10459-3204
US

IV. Provider business mailing address

60 MADISON AVE 5TH FLOOR
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-320-4466
  • Fax:
Mailing address:
  • Phone: 212-545-2400
  • Fax: 646-312-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339075-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: