1871733394 NPI number — MRS. ATIM EKONG OKENGWU PT

Table of content: MRS. ATIM EKONG OKENGWU PT (NPI 1871733394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871733394 NPI number — MRS. ATIM EKONG OKENGWU PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKENGWU
Provider First Name:
ATIM
Provider Middle Name:
EKONG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OKENGWU
Provider Other First Name:
ATIM
Provider Other Middle Name:
EKONG
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871733394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 ZIRKEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PISCATAWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08854-5714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-463-0187
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DELAIRE NURSING AND CONVALESCENT CENTER
Provider Second Line Business Practice Location Address:
400 WEST STIMPSON AVE
Provider Business Practice Location Address City Name:
LINDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07036-4499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-862-3399
Provider Business Practice Location Address Fax Number:
908-862-6967
Provider Enumeration Date:
02/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT40QA007134 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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