Healthcare Provider Details

I. General information

NPI: 1417584962
Provider Name (Legal Business Name): CHUKWUNWIKE P OKAFOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 W 58TH ST STE 11B
NEW YORK NY
10019-1108
US

IV. Provider business mailing address

343 W 58TH ST STE 11B
NEW YORK NY
10019-1108
US

V. Phone/Fax

Practice location:
  • Phone: 646-829-9274
  • Fax: 205-728-2546
Mailing address:
  • Phone: 646-829-9274
  • Fax: 205-728-2546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MA12290720
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number342823
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: