Provider Demographics
NPI:1538970785
Name:OKEREKE, CHIDI
Entity type:Individual
Prefix:
First Name:CHIDI
Middle Name:
Last Name:OKEREKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6528
Mailing Address - Country:US
Mailing Address - Phone:646-714-7001
Mailing Address - Fax:475-422-9425
Practice Address - Street 1:1825 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6528
Practice Address - Country:US
Practice Address - Phone:646-714-7001
Practice Address - Fax:475-422-9425
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY779260163WR0400X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation