Provider Demographics
NPI:1871733394
Name:OKENGWU, ATIM EKONG (PT)
Entity type:Individual
Prefix:MRS
First Name:ATIM
Middle Name:EKONG
Last Name:OKENGWU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ATIM
Other - Middle Name:EKONG
Other - Last Name:OKENGWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:14 ZIRKEL AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5714
Mailing Address - Country:US
Mailing Address - Phone:732-463-0187
Mailing Address - Fax:
Practice Address - Street 1:DELAIRE NURSING AND CONVALESCENT CENTER
Practice Address - Street 2:400 WEST STIMPSON AVE
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4499
Practice Address - Country:US
Practice Address - Phone:908-862-3399
Practice Address - Fax:908-862-6967
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA007134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist