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General NPI Number Information
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NPI Number | 1962675132
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Entity Type | Individual
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Provider Name | FAITH MARLENE MOGILA SCD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 37 CLYDE RD SUITE 103
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City | SOMERSET
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State | NJ
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Zip | 08873-5034
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Country | US
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Telephone | 732-873-6863
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Fax | 732-873-6853
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Provider Business Mailing Address
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Address Line | 372 ALDEBURGH AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-4869
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Country | US
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Telephone | 732-302-0039
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 719
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License Number State | NJ
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