Provider Demographics
NPI:1649743428
Name:OKA, MIMI (CSB)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:
Last Name:OKA
Suffix:
Gender:F
Credentials:CSB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 E 7TH ST PH 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6087
Mailing Address - Country:US
Mailing Address - Phone:212-358-1776
Mailing Address - Fax:
Practice Address - Street 1:259 E 7TH ST PH 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6087
Practice Address - Country:US
Practice Address - Phone:212-358-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner