1215927603 NPI number — MUYIWA AKIN OKURIBIDO DPM

Table of content: MUYIWA AKIN OKURIBIDO DPM (NPI 1215927603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215927603 NPI number — MUYIWA AKIN OKURIBIDO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKURIBIDO
Provider First Name:
MUYIWA
Provider Middle Name:
AKIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215927603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 RENAISSANCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08094-6331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-241-8295
Provider Business Mailing Address Fax Number:
856-504-0200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 RENAISSANCE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08094-6331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-241-8295
Provider Business Practice Location Address Fax Number:
856-504-0200
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  MD002566 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1932370483 . This is a "101 LUDLOW ST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1194996645 . This is a "444 WILLIAMS ST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1548431091 . This is a "982 BROAD ST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1063683258 . This is a "751 BROADWAY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1972778413 . This is a "1150 SPRINGFIELD AVE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1235300799 . This is a "37 N DAY ST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1740345693 . This is a "741 BROADWAY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1619148160 . This is a "516 BERGEN ST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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