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General NPI Number Information
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NPI Number | 1215927603
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Entity Type | Individual
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Provider Name | MUYIWA AKIN OKURIBIDO DPM
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 705 RENAISSANCE DR
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-6331
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Country | US
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Telephone | 732-241-8295
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Fax | 856-504-0200
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Provider Business Mailing Address
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Address Line | 705 RENAISSANCE DR
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-6331
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Country | US
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Telephone | 732-241-8295
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Fax | 856-504-0200
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | MD002566
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License Number State | NJ
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