Provider Demographics
NPI:1689612418
Name:MOGIL, JOAN G (NP)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:G
Last Name:MOGIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5032
Mailing Address - Country:US
Mailing Address - Phone:516-798-1066
Mailing Address - Fax:516-798-7351
Practice Address - Street 1:643 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5032
Practice Address - Country:US
Practice Address - Phone:516-798-1066
Practice Address - Fax:516-798-7351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301934-1207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01759604Medicaid
NY90V371Medicare ID - Type Unspecified
NY01759604Medicaid