Provider Demographics
NPI:1215452891
Name:OKOROCHA-IBE, COMFORT O (NP)
Entity type:Individual
Prefix:MRS
First Name:COMFORT
Middle Name:O
Last Name:OKOROCHA-IBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GRAVES ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5120
Mailing Address - Country:US
Mailing Address - Phone:646-427-4050
Mailing Address - Fax:
Practice Address - Street 1:774 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7038
Practice Address - Country:US
Practice Address - Phone:718-494-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307073363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health