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NPI Code Detail

MEDICARE: JENNIFER OKWEREKWU MD, MS

MEDICARE: JENNIFER OKWEREKWU MD, MS
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
12084P0800XPsychiatry Physician175414CA
22084P0800XPsychiatry Physician300887NY
32084P0800XPsychiatry Physician036.159616IL
42084P0800XPsychiatry Physician279287MA
5390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1336502616
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER OKWEREKWU MD, MS
Provider Business Mailing Address
First Line : 595 5TH AVE
Second Line :
City : TROY
State : NY
Zip : 12182-2501
Country : US
Telephone Number : 518-414-5421
Fax Number :
Provider Business Practice Location Address
First Line : 595 5TH AVE
Second Line :
City : TROY
State : NY
Zip : 12182-2501
Country : US
Telephone Number : 518-414-5421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2016
Last Update Date : 09/26/2022

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