Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00291200 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00291200 | NJ |
NPI | 1023230679 |
---|---|
Provider Name | Obinna O Mgbako |
First Address | Westfield, NJ 07090-2540 |
Second Address | Westfield, NJ 07090-2540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 14/03/2013 |