Healthcare Provider Details

I. General information

NPI: 1952608945
Provider Name (Legal Business Name): CHUDI MGBAKO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MILLBURN AVE STE 105
MILLBURN NJ
07041-1933
US

IV. Provider business mailing address

90 MILLBURN AVE STE 105
MILLBURN NJ
07041-1933
US

V. Phone/Fax

Practice location:
  • Phone: 973-200-7332
  • Fax: 833-764-6154
Mailing address:
  • Phone: 973-200-7332
  • Fax: 833-764-6154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00307300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00307300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: