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General NPI Number Information
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NPI Number | 1205306693
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Entity Type | Individual
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Provider Name | CHIDUBEM MATTHEW OBEGOLU MD
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Gender | Male
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 901 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2549
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Country | US
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Telephone | 732-431-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3036 HIGHWAY 35 STE 320
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City | HAZLET
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State | NJ
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Zip | 07730-1505
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Country | US
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Telephone | 817-217-4412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA11559300
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License Number State | NJ
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