Healthcare Provider Details

I. General information

NPI: 1225429947
Provider Name (Legal Business Name): NWABUNWANNE OKAFOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9406 KREWSTOWN RD
PHILADELPHIA PA
19115-3713
US

IV. Provider business mailing address

9406 KREWSTOWN RD
PHILADELPHIA PA
19115-3713
US

V. Phone/Fax

Practice location:
  • Phone: 215-715-7999
  • Fax:
Mailing address:
  • Phone: 215-715-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH002478
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: