Healthcare Provider Details

I. General information

NPI: 1508162009
Provider Name (Legal Business Name): MS. CAROL OKOBI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E SEAMAN AVE
FREEPORT NY
11520-1629
US

IV. Provider business mailing address

120 E SEAMAN AVE
FREEPORT NY
11520-1629
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-9225
  • Fax:
Mailing address:
  • Phone: 516-632-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number071038-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: