Provider Demographics
NPI:1710949441
Name:MOGLIA, PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MOGLIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 N BROADWAY
Mailing Address - Street 2:SUITE 411
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1318
Mailing Address - Country:US
Mailing Address - Phone:914-964-0336
Mailing Address - Fax:516-255-8453
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:SUITE 411
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1318
Practice Address - Country:US
Practice Address - Phone:914-964-0336
Practice Address - Fax:516-255-8453
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010055103TC0700X
NJ03589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01539959Medicaid
NJ7841302Medicaid
R52968Medicare UPIN
NJ023611RWJMedicare ID - Type UnspecifiedNJ GROUP MCARE PROV NO
NJ7841302Medicaid
NJ023611Medicare PIN
NY01539959Medicaid
NJ023611Medicare ID - Type UnspecifiedNJ MEDICARE PROVIDER NO
NJ023611RWJMedicare PIN
NYV61921Medicare PIN