Provider Demographics
NPI:1861515975
Name:OBIEFULE, CHIDIMMA MARILYN (PTA)
Entity type:Individual
Prefix:MISS
First Name:CHIDIMMA
Middle Name:MARILYN
Last Name:OBIEFULE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 EDENWALD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2212
Mailing Address - Country:US
Mailing Address - Phone:973-991-7258
Mailing Address - Fax:718-960-9154
Practice Address - Street 1:2014 EDENWALD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2212
Practice Address - Country:US
Practice Address - Phone:973-991-7258
Practice Address - Fax:718-960-9154
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00238100225200000X
NY006702225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant