Provider Demographics
NPI:1215927603
Name:OKURIBIDO, MUYIWA AKIN (DPM)
Entity type:Individual
Prefix:
First Name:MUYIWA
Middle Name:AKIN
Last Name:OKURIBIDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-6331
Mailing Address - Country:US
Mailing Address - Phone:732-241-8295
Mailing Address - Fax:856-504-0200
Practice Address - Street 1:705 RENAISSANCE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-6331
Practice Address - Country:US
Practice Address - Phone:732-241-8295
Practice Address - Fax:856-504-0200
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002566213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1932370483Other101 LUDLOW ST
NJ1194996645Other444 WILLIAMS ST
NJ1548431091Other982 BROAD ST
NJ1063683258Other751 BROADWAY
NJ1972778413Other1150 SPRINGFIELD AVE
NJ1235300799Other37 N DAY ST
NJ1740345693Other741 BROADWAY
NJ1619148160Other516 BERGEN ST
NJ1740345693Other741 BROADWAY
NJ1619148160Other516 BERGEN ST