Provider Demographics
NPI:1225372410
Name:FOGEL, MAGGIE F (DPT)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:F
Last Name:FOGEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-877-9000
Mailing Address - Fax:
Practice Address - Street 1:24 W 57TH ST
Practice Address - Street 2:SUITE 509
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3918
Practice Address - Country:US
Practice Address - Phone:212-707-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist