Provider Demographics
NPI:1023038890
Name:OKONKWO, CHINWE F (MD)
Entity Type:Individual
Prefix:
First Name:CHINWE
Middle Name:F
Last Name:OKONKWO
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 1:3 NORMAN CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5811
Mailing Address - Country:US
Mailing Address - Phone:631-423-2397
Mailing Address - Fax:631-643-5409
Practice Address - Street 1:887 RUTLAND RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1911
Practice Address - Country:US
Practice Address - Phone:718-756-3918
Practice Address - Fax:347-715-7135
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01623665Medicaid
NY752861Medicare PIN
G17838Medicare UPIN