Provider Demographics
NPI:1972670693
Name:UMANA, OKON E (MD)
Entity Type:Individual
Prefix:DR
First Name:OKON
Middle Name:E
Last Name:UMANA
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 1:2955 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2424
Mailing Address - Country:US
Mailing Address - Phone:718-676-6501
Mailing Address - Fax:718-676-6504
Practice Address - Street 1:2955 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2424
Practice Address - Country:US
Practice Address - Phone:718-676-6501
Practice Address - Fax:718-676-6504
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153743173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90D672OtherBLUE CROSS BLUE SHIELD
NY90D671Medicare ID - Type Unspecified
NYA400006015Medicare PIN
NYB1988Medicare UPIN