Healthcare Provider Details

I. General information

NPI: 1154572733
Provider Name (Legal Business Name): JOHN MOGLIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 SPRINGFIELD AVE
BERKELEY HTS NJ
07922-1056
US

IV. Provider business mailing address

668 SPRINGFIELD AVE
BERKELEY HTS NJ
07922-1056
US

V. Phone/Fax

Practice location:
  • Phone: 908-464-7977
  • Fax:
Mailing address:
  • Phone: 908-464-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD001156
License Number StateNJ

VIII. Authorized Official

Name: JOHN MOGLIA
Title or Position: OWNER
Credential: DPM
Phone: 908-464-7977