Healthcare Provider Details

I. General information

NPI: 1538648563
Provider Name (Legal Business Name): KESHIA SYLVIA OKORIE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ESSEX ST
NEW YORK NY
10002-2301
US

IV. Provider business mailing address

60 MADISON AVE FL 5
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-1120
  • Fax: 212-477-8957
Mailing address:
  • Phone: 212-545-2400
  • Fax: 646-312-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number009423
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: