Organization Active NPI

MTB Mobile Podiatry

  • Podiatric Clinic/Center
  • Kearny, NJ
National Provider Identifier
1346035045
Registry record updated Apr 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
Legal business name
MTB MOBILE PODIATRY
Doing business as
MTB Mobile Podiatry
Practice address
300 Hoyt St Apt 106
Kearny, NJ 07032-4641
Phone
(617) 840-2082
NPI assigned
Apr 12, 2025
Last updated
Apr 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Olufunke Oburaimoh, DPM
Title
Physician
Phone
(617) 840-2082

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatric Clinic/Center 261QP1100X Primary

Addresses

Primary practice location

300 Hoyt St Apt 106
Kearny, NJ 07032-4641

Mailing address

300 Hoyt St
Unit 106
Kearny, NJ 07032-4641
Phone (617) 840-2082

Other names 1

  • MTB Mobile Podiatry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251027000490 NJ Part B Supplier - Clinic/Group Practice 1052800570 Receives reassigned benefits from 1 practitioner
Practice locations: Kearny, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744416000000",
    "number": "1346035045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HOYT ST",
            "address_2": "UNIT 106",
            "city": "KEARNY",
            "state": "NJ",
            "postal_code": "070324641",
            "telephone_number": "617-840-2082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HOYT ST APT 106",
            "city": "KEARNY",
            "state": "NJ",
            "postal_code": "070324641",
            "telephone_number": "617-840-2082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MTB MOBILE PODIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-12",
        "last_updated": "2025-04-12",
        "certification_date": "2025-04-12",
        "status": "A",
        "authorized_official_last_name": "OBURAIMOH",
        "authorized_official_first_name": "OLUFUNKE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "617-840-2082",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MTB Mobile Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kearny, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.