Provider Demographics
NPI:1689315780
Name:UGBOGBO, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:UGBOGBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SOUTH 1ST STREET
Mailing Address - Street 2:THE EDDY, APT.501
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029
Mailing Address - Country:US
Mailing Address - Phone:646-326-1648
Mailing Address - Fax:
Practice Address - Street 1:9 MULE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5043
Practice Address - Country:US
Practice Address - Phone:732-797-1535
Practice Address - Fax:732-797-1595
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12489700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine