Classic Wellness Family Medical Practice LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

26NJ00257300 Issued in NJ

Legal business name

CLASSIC WELLNESS FAMILY MEDICAL PRACTICE LLC

Practice address

1220 Victor Ave
Union, NJ 07083-3706

Phone

(718) 753-1721

NPI assigned

Jul 14, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daniel D Okoro, DNP, APNNPI 1023325172

Title

Doctor of Nursing Practice, Apn

Phone

(718) 753-1721

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel D Okoro, DNP, APN

  • Family Nurse Practitioner
  • Union, NJ
  • NPI 1023325172
  Medicare reassignment Authorized official
• Chinenye Okoro

  • Psychiatric/Mental Health Nurse Practitioner
  • Union, NJ
  • NPI 1790019644
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493251200000",
    "number": "1376950279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 VICTOR AVE",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070833706",
            "telephone_number": "718-753-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 VICTOR AVE",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070833706",
            "telephone_number": "718-753-1721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLASSIC WELLNESS FAMILY MEDICAL PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-14",
        "last_updated": "2017-04-27",
        "status": "A",
        "authorized_official_last_name": "OKORO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DOCTOR OF NURSING PRACTICE, APN",
        "authorized_official_telephone_number": "718-753-1721",
        "authorized_official_credential": "DNP, APN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "26NJ00257300",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "NJ",
            "license": "26NJ00257300",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "26NJ00257300",
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NJ",
            "license": "26NJ00257300",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0453951",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Hasan Chung, D.D.S
• Almira R. Churchill
• Matthew Cirelli, DPT
• City Medical of New Jersey, PC
• Classic Medical Practice
• Classic Wellness Family Mental Health Practice LLC
• Clear Thoughts Healthcare LLC
• Marianne Cabezas Cleary, PA-C
• Gwen Cleaves
• Clinical Laboratory Manangement, Inc

• Primary Care Clinic/Center in Union, NJ
• Providers in Union, NJ by specialty
• Primary Care Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.