Provider Demographics
NPI:1124564596
Name:COGDILL, NATHAN MATTHEW (ATC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:MATTHEW
Last Name:COGDILL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2813
Mailing Address - Country:US
Mailing Address - Phone:732-735-3231
Mailing Address - Fax:
Practice Address - Street 1:200 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-3566
Practice Address - Country:US
Practice Address - Phone:732-521-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000951002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer