Provider Demographics
NPI:1326228958
Name:OKOYE, ODILI
Entity Type:Individual
Prefix:MS
First Name:ODILI
Middle Name:
Last Name:OKOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 RIVER ST STE A
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2121
Mailing Address - Country:US
Mailing Address - Phone:781-492-7722
Mailing Address - Fax:617-361-1700
Practice Address - Street 1:1378 RIVER ST STE A
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2121
Practice Address - Country:US
Practice Address - Phone:781-492-7722
Practice Address - Fax:617-361-1700
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6389720001Medicare NSC