Provider Demographics
NPI:1154876571
Name:OKOYE, CHARLES OBUM
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:OBUM
Last Name:OKOYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11942 179TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1942
Mailing Address - Country:US
Mailing Address - Phone:646-379-7550
Mailing Address - Fax:
Practice Address - Street 1:11942 179TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1942
Practice Address - Country:US
Practice Address - Phone:646-379-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY717566163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse