Healthcare Provider Details

I. General information

NPI: 1366886459
Provider Name (Legal Business Name): RITA C OKOLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DOUGLAS ST
INWOOD NY
11096-1340
US

IV. Provider business mailing address

5 DOUGLAS ST
INWOOD NY
11096-1340
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-5592
  • Fax:
Mailing address:
  • Phone: 718-459-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number313862-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: