Provider Demographics
NPI:1821306382
Name:ROSELINE OKON MD LLC
Entity Type:Organization
Organization Name:ROSELINE OKON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OKON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-970-7037
Mailing Address - Street 1:PO BOX 39063
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-0063
Mailing Address - Country:US
Mailing Address - Phone:440-352-4321
Mailing Address - Fax:
Practice Address - Street 1:6210 CEDAR CT
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-5941
Practice Address - Country:US
Practice Address - Phone:440-352-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-18
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0877762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty