Healthcare Provider Details

I. General information

NPI: 1053949222
Provider Name (Legal Business Name): ANNELI OKWUONU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11915 ROCKAWAY BEACH BLVD
ROCKAWAY PARK NY
11694-1970
US

IV. Provider business mailing address

11915 ROCKAWAY BEACH BLVD
ROCKAWAY PARK NY
11694-1970
US

V. Phone/Fax

Practice location:
  • Phone: 718-634-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1936
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number011888-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: