Provider Demographics
NPI:1992062749
Name:OKPALA, NKEMAMAKA CHINENYENWA (MD)
Entity type:Individual
Prefix:
First Name:NKEMAMAKA
Middle Name:CHINENYENWA
Last Name:OKPALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 SAND SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5504
Mailing Address - Country:US
Mailing Address - Phone:862-254-2299
Mailing Address - Fax:862-254-2300
Practice Address - Street 1:433 SAND SHORE RD
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-5504
Practice Address - Country:US
Practice Address - Phone:862-254-2299
Practice Address - Fax:862-254-2300
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09363400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0379239Medicaid