Provider Demographics
NPI:1881690998
Name:MOGER, FLORIAN B
Entity Type:Individual
Prefix:
First Name:FLORIAN
Middle Name:B
Last Name:MOGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD YORK ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2872
Mailing Address - Country:US
Mailing Address - Phone:215-886-0174
Mailing Address - Fax:
Practice Address - Street 1:500 OLD YORK ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2872
Practice Address - Country:US
Practice Address - Phone:215-886-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009519L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039328LVRMedicare PIN