Healthcare Provider Details

I. General information

NPI: 1588172340
Provider Name (Legal Business Name): MARC A ROGOL BSN, RN, CEN, MICN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CARNIE BLVD
VOORHEES NJ
08043-4515
US

IV. Provider business mailing address

PO BOX 8056
TRENTON NJ
08650-0056
US

V. Phone/Fax

Practice location:
  • Phone: 856-581-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number26NR15462600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN694575
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN694575
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR15462600
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR15462600
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number26NR15462600
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN694575
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: