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General NPI Number Information
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NPI Number | 1164983268
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Entity Type | Organization
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Legal Business Name | GBOLAHAN O. OKUBADEJO, M.D PC
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 03/29/2019
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Provider Practice Location Address
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Address Line | 32 MARQUIS CT
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City | EDGEWATER
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State | NJ
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Zip | 07020-2900
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Country | US
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Telephone | 877-854-8274
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Fax |
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Provider Business Mailing Address
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Address Line | 32 MARQUIS CT
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City | EDGEWATER
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State | NJ
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Zip | 07020-2900
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Country | US
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Telephone | 877-854-8274
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MARY M. LEGG
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Credential |
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Telephone | 347-584-8903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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