Healthcare Provider Details

I. General information

NPI: 1619264017
Provider Name (Legal Business Name): CHIDI OGBONNA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHIDI OGBONNA D.P.M.

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E 48TH ST 6TH FLOOR
NEW YORK NY
10017-1017
US

IV. Provider business mailing address

45 W 132ND ST 5T
NEW YORK NY
10037
US

V. Phone/Fax

Practice location:
  • Phone: 917-388-3778
  • Fax: 646-219-4689
Mailing address:
  • Phone: 917-388-3778
  • Fax: 646-219-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: