Provider Demographics
NPI:1255878211
Name:OKONKWO, ISIOMA
Entity type:Individual
Prefix:MRS
First Name:ISIOMA
Middle Name:
Last Name:OKONKWO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 WINDING RD
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2137
Mailing Address - Country:US
Mailing Address - Phone:678-598-0840
Mailing Address - Fax:678-653-8467
Practice Address - Street 1:260 WINDING RD
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2137
Practice Address - Country:US
Practice Address - Phone:678-598-0840
Practice Address - Fax:678-653-8467
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ045077557171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator