Provider Demographics
NPI:1417336397
Name:OSOKPO, ONOME (RN)
Entity Type:Individual
Prefix:MR
First Name:ONOME
Middle Name:
Last Name:OSOKPO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W LAKELAND ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2622
Mailing Address - Country:US
Mailing Address - Phone:631-647-4121
Mailing Address - Fax:
Practice Address - Street 1:12 W LAKELAND ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2622
Practice Address - Country:US
Practice Address - Phone:631-647-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY663493163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse