Provider Demographics
NPI:1710463336
Name:OKKEN, JOHN N (HAD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:OKKEN
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4200
Mailing Address - Country:US
Mailing Address - Phone:908-583-5284
Mailing Address - Fax:908-583-6297
Practice Address - Street 1:225 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4200
Practice Address - Country:US
Practice Address - Phone:908-583-5284
Practice Address - Fax:908-583-6297
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00038600237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0593842Medicaid