Provider Demographics
NPI:1124085766
Name:OKPALA, AUGUSTINE CHUKWUJEKWU (MD)
Entity type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:CHUKWUJEKWU
Last Name:OKPALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1004
Mailing Address - Country:US
Mailing Address - Phone:973-579-8321
Mailing Address - Fax:
Practice Address - Street 1:175 HIGH ST
Practice Address - Street 2:NEWTON MEMORIAL HOSPITAL
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1004
Practice Address - Country:US
Practice Address - Phone:973-579-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08035200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00808383OtherRR MEDICARE
NJ0105821Medicaid
NJP00808383OtherRR MEDICARE
NJ101878ZDQ0Medicare PIN