Basic Information
| Provider Information | |||||||||
| NPI: | 1639797418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OKEREKE | ||||||||
| FirstName: | IKECHUKWU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 529 BEACH 20TH ST | ||||||||
| Address2: | |||||||||
| City: | FAR ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116913615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183277307 | ||||||||
| FaxNumber: | 7183273294 | ||||||||
| Practice Location | |||||||||
| Address1: | 529 BEACH 20TH ST | ||||||||
| Address2: | |||||||||
| City: | FAR ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116913615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183277307 | ||||||||
| FaxNumber: | 7183273294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2020 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 105709-01 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.