Provider Demographics
NPI:1285706168
Name:OKENE, OVUNDAH EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:OVUNDAH
Middle Name:EDWIN
Last Name:OKENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:99 EAST STATE STREET
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-0100
Mailing Address - Country:US
Mailing Address - Phone:518-775-4205
Mailing Address - Fax:518-775-4225
Practice Address - Street 1:23 SOUTH PERRY STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-0000
Practice Address - Country:US
Practice Address - Phone:518-736-1500
Practice Address - Fax:518-762-8194
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY211429207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3043440OtherMVP HEALTH PLAN
NY01971815Medicaid
NYG88612Medicare UPIN
NYJ400017798Medicare PIN