Provider Demographics
NPI:1710176854
Name:MOGOL, FROILAN MAAC (PT)
Entity Type:Individual
Prefix:MR
First Name:FROILAN
Middle Name:MAAC
Last Name:MOGOL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ATHENIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2639
Mailing Address - Country:US
Mailing Address - Phone:973-393-6197
Mailing Address - Fax:
Practice Address - Street 1:94 ATHENIA AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2639
Practice Address - Country:US
Practice Address - Phone:973-393-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29182225100000X
NJ40QA01273200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist