Provider Demographics
NPI:1043234693
Name:MOGUL, HARRIETTE ROSEN (MD)
Entity Type:Individual
Prefix:
First Name:HARRIETTE
Middle Name:ROSEN
Last Name:MOGUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HARRIETTE
Other - Middle Name:ROSRN
Other - Last Name:MOGUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD MPH
Mailing Address - Street 1:401 COLUMBUS AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1326
Mailing Address - Country:US
Mailing Address - Phone:914-473-0162
Mailing Address - Fax:914-347-4401
Practice Address - Street 1:401 COLUMBUS AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1326
Practice Address - Country:US
Practice Address - Phone:914-347-0162
Practice Address - Fax:914-347-4401
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104864207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
110063317OtherRAILROAD MEDICARE
NYWP341OtherOXFORD
NY01415443Medicaid