Healthcare Provider Details

I. General information

NPI: 1437214749
Provider Name (Legal Business Name): JOHN L. MOGLIA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
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: 908-464-7745
Mailing address:
  • Phone: 908-464-7977
  • Fax: 908-464-7745

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:
Title or Position:
Credential:
Phone: