Healthcare Provider Details

I. General information

NPI: 1821332545
Provider Name (Legal Business Name): MILTON CHIMA OKWUOHA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 QUEENS BLVD STE 604 STE 604
ELMHURST NY
11373-5501
US

IV. Provider business mailing address

9720 57TH AVE APT 17J
CORONA NY
11368-3539
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-7000
  • Fax:
Mailing address:
  • Phone: 917-385-8832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number592302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: