Organization
CLASSIC WELLNESS FAMILY MEDICAL PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL D OKORO DNP, APN (DOCTOR OF NURSING PRACTICE, APN)
(718) 753-1721
Entity
Organization
Contact information
Practice address
1220 VICTOR AVE, UNION, NJ 07083-3706
(718) 753-1721
Mailing address
1220 VICTOR AVE, UNION, NJ 07083-3706
(718) 753-1721
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
26NJ00257300
NJ
208D00000X
General Practice Physician
26NJ00257300
NJ
261QP2300X
Primary Care Clinic/Center
Primary
26NJ00257300
NJ
261QP3300X
Pain Clinic/Center
26NJ00257300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0453951
—
NJ
Enumeration date
07/14/2014
Last updated
04/27/2017
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