Provider Demographics
NPI:1407409790
Name:OLEKA, ANTHONY IFEANYI
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:IFEANYI
Last Name:OLEKA
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 1:1786 MANOR DR APT B
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1045
Mailing Address - Country:US
Mailing Address - Phone:862-218-4241
Mailing Address - Fax:
Practice Address - Street 1:1786 MANOR DR APT B
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1045
Practice Address - Country:US
Practice Address - Phone:862-218-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09165500224Z00000X
NY009568224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty