Provider Demographics
NPI:1801602842
Name:NJOKOM, OMRI FORKEH
Entity type:Individual
Prefix:
First Name:OMRI
Middle Name:FORKEH
Last Name:NJOKOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11103 ELON CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3505
Mailing Address - Country:US
Mailing Address - Phone:240-906-1581
Mailing Address - Fax:
Practice Address - Street 1:11103 ELON CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3505
Practice Address - Country:US
Practice Address - Phone:240-906-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1447556600171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator