Provider Demographics
NPI:1528478260
Name:OKADA, JEFFREY
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:OKADA
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 1:2855 E MANOA RD STE 105
Mailing Address - Street 2:BOX #200
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822
Mailing Address - Country:US
Mailing Address - Phone:808-941-6300
Mailing Address - Fax:808-440-0111
Practice Address - Street 1:1554 NORTHERN BLVD FL 4
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3053
Practice Address - Country:US
Practice Address - Phone:165-321-6400
Practice Address - Fax:516-321-6420
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-03
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-22253208100000X
390200000X
NY301097208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program