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1164429361

NPI Code Detail

MEDICARE: CORA O OGBOLU MD

MEDICARE: CORA O OGBOLU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA07727300	NJ
2	207RN0300X	Nephrology Physician	324972	NY

General Provider Information

NPI Number	:	1164429361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORA O OGBOLU MD

Provider Business Mailing Address
First Line	:	400 GILL LN
Second Line	:
City	:	ISELIN
State	:	NJ
Zip	:	08830-3001
Country	:	US
Telephone Number	:	732-404-1580
Fax Number	:	732-404-1594

Provider Business Practice Location Address
First Line	:	400 GILL LN
Second Line	:
City	:	ISELIN
State	:	NJ
Zip	:	08830-3001
Country	:	US
Telephone Number	:	732-404-1580
Fax Number	:	732-404-1594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	09/18/2024

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1487674867 — AVENEL ISELIN MEDICAL GROUP, LLC
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Directions to “ CORA O OGBOLU MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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