1376097774 NPI number — IJOMA OKWUOSA

Table of content: JULIE STOOPS MS, RD, LDN (NPI 1477171601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376097774 NPI number — IJOMA OKWUOSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IJOMA OKWUOSA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376097774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 MORRIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06512-4421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-665-4132
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 MORRIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06512-4421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-665-4132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
OKWUOSA
Authorized Official First Name:
IJOMA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRIMARY THERAPIST
Authorized Official Telephone Number:
678-665-4132

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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