Provider Demographics
NPI:1467634360
Name:OBI, MANFRED KANU (MD)
Entity type:Individual
Prefix:DR
First Name:MANFRED
Middle Name:KANU
Last Name:OBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ONWUASO
Other - Middle Name:KANU MANFRED
Other - Last Name:OBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5087
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-5087
Mailing Address - Country:US
Mailing Address - Phone:973-951-0653
Mailing Address - Fax:908-469-2135
Practice Address - Street 1:1235 MORRIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3344
Practice Address - Country:US
Practice Address - Phone:908-258-7759
Practice Address - Fax:908-469-2135
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA083283002084P0800X, 2084F0202X
NY60 2516982084P0800X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry