MEDICARE: DR. OVUNDAH EDWIN OKENE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	211429	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3043440	OTHER	NY	MVP HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285706168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OVUNDAH EDWIN OKENE MD

Provider Business Mailing Address
First Line	:	99 EAST STATE STREET
Second Line	:	PO BOX 1250
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-0100
Country	:	US
Telephone Number	:	518-775-4205
Fax Number	:	518-775-4225

Provider Business Practice Location Address
First Line	:	23 SOUTH PERRY STREET
Second Line	:
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-0000
Country	:	US
Telephone Number	:	518-736-1500
Fax Number	:	518-762-8194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	02/10/2011

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