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General NPI Number Information
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NPI Number | 1407409790
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Entity Type | Individual
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Provider Name | ANTHONY IFEANYI OLEKA
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Gender | Male
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 1786 MANOR DR APT B
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City | IRVINGTON
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State | NJ
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Zip | 07111-1045
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Country | US
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Telephone | 862-218-4241
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Fax |
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Provider Business Mailing Address
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Address Line | 1786 MANOR DR APT B
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City | IRVINGTON
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State | NJ
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Zip | 07111-1045
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Country | US
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Telephone | 862-218-4241
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 46TA09165500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 009568
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License Number State | NY
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