Provider Demographics
NPI:1154572733
Name:JOHN MOGLIA
Entity type:Organization
Organization Name:JOHN MOGLIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-464-7977
Mailing Address - Street 1:668 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1056
Mailing Address - Country:US
Mailing Address - Phone:908-464-7977
Mailing Address - Fax:
Practice Address - Street 1:668 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1056
Practice Address - Country:US
Practice Address - Phone:908-464-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD001156213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4181070001Medicare NSC