Provider Demographics
NPI:1528358652
Name:OKAO, EWAEN OSAMUYI (MD,)
Entity Type:Individual
Prefix:
First Name:EWAEN
Middle Name:OSAMUYI
Last Name:OKAO
Suffix:
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 1:661 SHREWSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4183
Mailing Address - Country:US
Mailing Address - Phone:732-345-3400
Mailing Address - Fax:732-345-3104
Practice Address - Street 1:13 N HARTFORD AVE
Practice Address - Street 2:ATLANTICARE BEHAVIORAL HEALTH
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-3512
Practice Address - Country:US
Practice Address - Phone:609-348-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA092353002084A0401X, 2084P0800X
PAMD4423952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine