Healthcare Provider Details

I. General information

NPI: 1649776493
Provider Name (Legal Business Name): SHEENA MAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONROE ST
BRIDGEWATER NJ
08807-3043
US

IV. Provider business mailing address

25 MONROE ST
BRIDGEWATER NJ
08807-3043
US

V. Phone/Fax

Practice location:
  • Phone: 908-231-1999
  • Fax: 908-231-1612
Mailing address:
  • Phone: 908-231-1999
  • Fax: 908-231-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MB13019200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOT020788
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number328738
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: