Provider Demographics
NPI:1316082118
Name:FOGEL, NANCY R (CNM)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:FOGEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1759
Mailing Address - Country:US
Mailing Address - Phone:973-746-3148
Mailing Address - Fax:973-746-3540
Practice Address - Street 1:220 HAMBURG TPKE
Practice Address - Street 2:SUITE 21
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2110
Practice Address - Country:US
Practice Address - Phone:973-790-8090
Practice Address - Fax:973-790-3198
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00015801367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife