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General NPI Number Information
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NPI Number | 1770103087
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Entity Type | Individual
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Provider Name | MOKSHA P VANGALA
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Gender | Female
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 1200 US HIGHWAY 22 STE 3
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2943
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Country | US
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Telephone | 732-390-7750
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Fax |
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Provider Business Mailing Address
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Address Line | 629 CRANBURY RD FL 2
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4096
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Country | US
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Telephone | 732-390-7750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 25MA12652000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA12652000
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License Number State | NJ
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