Provider Demographics
NPI:1043876030
Name:OKOBI, AUSTIN I
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:I
Last Name:OKOBI
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 1:1500 ASTOR AVE LBBY 1A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5900
Mailing Address - Country:US
Mailing Address - Phone:347-571-2179
Mailing Address - Fax:718-585-4857
Practice Address - Street 1:1500 ASTOR AVE LBBY 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5900
Practice Address - Country:US
Practice Address - Phone:347-571-2179
Practice Address - Fax:718-585-4857
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency