Provider Demographics
NPI:1568475572
Name:MOWEN, GREGORY J
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:MOWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 VENTNOR AVE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2149
Mailing Address - Country:US
Mailing Address - Phone:609-822-8300
Mailing Address - Fax:609-487-9305
Practice Address - Street 1:6620 VENTNOR AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2149
Practice Address - Country:US
Practice Address - Phone:609-822-8300
Practice Address - Fax:609-487-9305
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002079213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
719513Medicare ID - Type Unspecified
T93438Medicare UPIN