Provider Demographics
NPI:1114186582
Name:OKOLI, OSCAR B (RPA-C)
Entity type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:B
Last Name:OKOLI
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-6303
Mailing Address - Fax:718-920-6303
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:MONTEFIORE MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-6303
Practice Address - Fax:718-920-6303
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2009-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331947Medicare PIN
NY331956Medicare PIN
NY09487Medicare PIN
NYW6L111Medicare PIN
NY331952Medicare PIN
NY331945Medicare PIN
NY331954Medicare PIN
NY331978Medicare PIN
NY00695941Medicaid
NY331944Medicare PIN
NY331957Medicare PIN
NY331943Medicare PIN