Healthcare Provider Details

I. General information

NPI: 1780470500
Provider Name (Legal Business Name): DANIEL CHIDIEBERE UDEGBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE STREET DEPARTMENT OF MEDICINE
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

350 ENGLE STREET DEPARTMENT OF MEDICINE
ENGLEWOOD NJ
07631
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3664
  • Fax: 201-894-0839
Mailing address:
  • Phone: 201-894-3664
  • Fax: 201-894-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: