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General NPI Number Information
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NPI Number | 1285706168
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Entity Type | Individual
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Provider Name | OVUNDAH EDWIN OKENE MD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 23 SOUTH PERRY STREET
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City | JOHNSTOWN
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State | NY
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Zip | 12095-0000
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Country | US
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Telephone | 518-736-1500
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Fax | 518-762-8194
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Provider Business Mailing Address
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Address Line | 99 EAST STATE STREET PO BOX 1250
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-0100
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Country | US
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Telephone | 518-775-4205
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Fax | 518-775-4225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 211429
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License Number State | NY
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