Provider Demographics
NPI:1659345429
Name:MOGERMAN JASON ORTHOPAEDIC INSTITUTE,LLC
Entity Type:Organization
Organization Name:MOGERMAN JASON ORTHOPAEDIC INSTITUTE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-488-9880
Mailing Address - Street 1:27A WOODLANDS DR
Mailing Address - Street 2:
Mailing Address - City:WAYMART
Mailing Address - State:PA
Mailing Address - Zip Code:18472-9366
Mailing Address - Country:US
Mailing Address - Phone:570-488-9880
Mailing Address - Fax:
Practice Address - Street 1:27A WOODLANDS DR
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472-9366
Practice Address - Country:US
Practice Address - Phone:570-488-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001880725Medicaid
1343003OtherBS
057437Medicare PIN