Provider Demographics
NPI:1346035045
Name:MTB MOBILE PODIATRY
Entity type:Organization
Organization Name:MTB MOBILE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:OLUFUNKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBURAIMOH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-840-2082
Mailing Address - Street 1:300 HOYT ST
Mailing Address - Street 2:UNIT 106
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-4641
Mailing Address - Country:US
Mailing Address - Phone:617-840-2082
Mailing Address - Fax:
Practice Address - Street 1:300 HOYT ST APT 106
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-4641
Practice Address - Country:US
Practice Address - Phone:617-840-2082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric