Provider Demographics
NPI:1861669749
Name:OBIDIGBO, HENRIETTA IFEOMA (DPM)
Entity Type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:IFEOMA
Last Name:OBIDIGBO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 CUSHING PL
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-2202
Mailing Address - Country:US
Mailing Address - Phone:973-216-9071
Mailing Address - Fax:
Practice Address - Street 1:944 CUSHING PL
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062-2202
Practice Address - Country:US
Practice Address - Phone:973-216-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00296100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist