Provider Demographics
NPI:1053152918
Name:OKUNKPOLOR, OSAKPOLOR FRANCIS
Entity type:Individual
Prefix:
First Name:OSAKPOLOR
Middle Name:FRANCIS
Last Name:OKUNKPOLOR
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 1:63 WINANS AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-2029
Mailing Address - Country:US
Mailing Address - Phone:646-784-5871
Mailing Address - Fax:
Practice Address - Street 1:63 WINANS AVE APT 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-2029
Practice Address - Country:US
Practice Address - Phone:646-784-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health