Provider Demographics
NPI:1578991055
Name:MAGER & GOUGELMAN, INC
Entity Type:Organization
Organization Name:MAGER & GOUGELMAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-661-3939
Mailing Address - Street 1:345 E 37TH ST
Mailing Address - Street 2:SUITE #316
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3256
Mailing Address - Country:US
Mailing Address - Phone:212-661-3939
Mailing Address - Fax:212-661-0576
Practice Address - Street 1:200 ORCHARD ST
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5363
Practice Address - Country:US
Practice Address - Phone:203-773-1753
Practice Address - Fax:203-773-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier