Provider Demographics
NPI:1518210343
Name:OKUONGHAE, CYNTHIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:OKUONGHAE
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 1:790 ELDERT LN
Mailing Address - Street 2:# 16E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4753
Mailing Address - Country:US
Mailing Address - Phone:917-749-1687
Mailing Address - Fax:
Practice Address - Street 1:790 ELDERT LN
Practice Address - Street 2:# 16E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4753
Practice Address - Country:US
Practice Address - Phone:917-749-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604838-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse