Organization
CLASSIC MEDICAL PRACTICE
Active
Organization
CLASSIC MEDICAL PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL OKORO DNP, APN (CHIEF EXECUTIVE OFFICE)
(908) 230-2750
Entity
Organization
Contact information
Practice address
540 NORTH AVE STE 3, UNION, NJ 07083-7149
(718) 753-1721
Mailing address
1105 GALLOPING HILL RD, ELIZABETH, NJ 07208-1008
(908) 230-2750
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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