Provider Demographics
NPI:1497554596
Name:OKONKWO, RUTH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:OKONKWO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:ALOZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:712 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2907
Mailing Address - Country:US
Mailing Address - Phone:917-607-5695
Mailing Address - Fax:
Practice Address - Street 1:130 W KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3904
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT175083163W00000X
NY724633163W00000X
CT14575363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse