Provider Demographics
NPI:1841263423
Name:OKOME, MUOYO (PHD,PT)
Entity type:Individual
Prefix:DR
First Name:MUOYO
Middle Name:
Last Name:OKOME
Suffix:
Gender:M
Credentials:PHD,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 E 18TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1801
Mailing Address - Country:US
Mailing Address - Phone:347-249-6501
Mailing Address - Fax:
Practice Address - Street 1:724 E 18TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1801
Practice Address - Country:US
Practice Address - Phone:347-249-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8361-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ55751Medicare ID - Type Unspecified
NYR50194Medicare UPIN