Provider Demographics
NPI:1619264017
Name:OGBONNA, CHIDI (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHIDI
Middle Name:
Last Name:OGBONNA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:CHIDI
Other - Middle Name:
Other - Last Name:OGBONNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:45 W 132ND ST
Mailing Address - Street 2:5T
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037
Mailing Address - Country:US
Mailing Address - Phone:917-388-3778
Mailing Address - Fax:646-219-4689
Practice Address - Street 1:16 E 48TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1017
Practice Address - Country:US
Practice Address - Phone:917-388-3778
Practice Address - Fax:646-219-4689
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006412213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery