Provider Demographics
NPI:1609989797
Name:MAGER & GOUGELMAN, INC
Entity Type:Organization
Organization Name:MAGER & GOUGELMAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOUGELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:212-661-3939
Mailing Address - Street 1:144 E 44TH ST STE 602
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4008
Mailing Address - Country:US
Mailing Address - Phone:212-661-0576
Mailing Address - Fax:212-661-0576
Practice Address - Street 1:144 E 44TH ST STE 602
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4008
Practice Address - Country:US
Practice Address - Phone:212-661-3939
Practice Address - Fax:212-661-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00342425Medicaid
NY0394980001Medicare NSC