Healthcare Provider Details

I. General information

NPI: 1215927603
Provider Name (Legal Business Name): MUYIWA AKIN OKURIBIDO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RENAISSANCE DR
WILLIAMSTOWN NJ
08094-6331
US

IV. Provider business mailing address

705 RENAISSANCE DR
WILLIAMSTOWN NJ
08094-6331
US

V. Phone/Fax

Practice location:
  • Phone: 732-241-8295
  • Fax: 856-504-0200
Mailing address:
  • Phone: 732-241-8295
  • Fax: 856-504-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD002566
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: