Provider Demographics
NPI:1326049644
Name:MOGIL, LAUREY GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREY
Middle Name:GAIL
Last Name:MOGIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3605
Mailing Address - Country:US
Mailing Address - Phone:718-645-0600
Mailing Address - Fax:718-692-4456
Practice Address - Street 1:1301 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3605
Practice Address - Country:US
Practice Address - Phone:718-645-0600
Practice Address - Fax:718-692-4456
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146461207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00923964Medicaid
NY00923964Medicaid
NYB14931Medicare UPIN