Healthcare Provider Details

I. General information

NPI: 1821611963
Provider Name (Legal Business Name): CHRISTOPHER OBODE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2020
Last Update Date: 05/23/2020
Certification Date: 05/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 SANFORD AVE
NEWARK NJ
07106-3630
US

IV. Provider business mailing address

619 HUNTINGTON AVE
PLAINFIELD NJ
07060-2745
US

V. Phone/Fax

Practice location:
  • Phone: 908-378-5012
  • Fax: 908-548-0947
Mailing address:
  • Phone: 908-244-5709
  • Fax: 908-548-0947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: