Provider Demographics
NPI:1306815618
Name:OKOYE, FREDERICK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:OKOYE
Suffix:JR
Gender:M
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:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-0428
Mailing Address - Country:US
Mailing Address - Phone:973-249-1855
Mailing Address - Fax:973-249-1856
Practice Address - Street 1:642 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1615
Practice Address - Country:US
Practice Address - Phone:973-249-1855
Practice Address - Fax:973-249-1856
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63691207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7801505Medicaid
NJ7801505Medicaid
NJ022067Medicare ID - Type Unspecified