Provider Demographics
NPI:1063038735
Name:IKIE, OKEROGHENE JUDE
Entity Type:Individual
Prefix:
First Name:OKEROGHENE
Middle Name:JUDE
Last Name:IKIE
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 1:1435 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5133
Mailing Address - Country:US
Mailing Address - Phone:917-561-0039
Mailing Address - Fax:
Practice Address - Street 1:122 W 27TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6271
Practice Address - Country:US
Practice Address - Phone:212-991-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311270-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse