Provider Demographics
NPI:1023230679
Name:MGBAKO, OBINNA O (DPM)
Entity type:Individual
Prefix:
First Name:OBINNA
Middle Name:O
Last Name:MGBAKO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CENTRAL AVENUE
Mailing Address - Street 2:IN CARE OF WESTFIELD PODIATRY
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2540
Mailing Address - Country:US
Mailing Address - Phone:908-232-3346
Mailing Address - Fax:908-232-6920
Practice Address - Street 1:715 CENTRAL AVENUE
Practice Address - Street 2:IN CARE OF WESTFIELD PODIATRY
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2540
Practice Address - Country:US
Practice Address - Phone:908-232-3346
Practice Address - Fax:908-232-6920
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00291200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist