Provider Demographics
NPI:1891799771
Name:VOGEL, MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:VOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 BROAD ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3039
Mailing Address - Country:US
Mailing Address - Phone:973-779-0808
Mailing Address - Fax:973-471-1929
Practice Address - Street 1:1455 BROAD ST STE 110
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3039
Practice Address - Country:US
Practice Address - Phone:973-779-0808
Practice Address - Fax:973-471-1929
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06370000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
223589980OtherIDA ID NUMBER
223589980OtherMAIL HANDLERS PLAN ID
180033572OtherRAILROAD MEDICARE
223589980OtherAARP ID NUMBER
P1094006OtherOXFORD ID NUMBER
1051800OtherAETNA IND PROV NUMBER
223589980OtherFIRST HEALTH ID NUMBER
96T25OtherEMPIRE BLUE CROSS ID
223589980OtherPHCS ID NUMBER
NJ7650809Medicaid
223589980OtherNALC ID NUMBER
223589980OtherCORESOURCE ID NUMBER
OK8636OtherHEALTH NET ID NUMBER
0656338OtherCIGNA PROVIDER NUMBER
1816887OtherUNITED HEALTHCARE ID
NJ223589980OtherHORIZON BCBSNJ ID NUMBER
223589980OtherBEECH STREET ID NUMBER
G16031Medicare UPIN
NJ010746V80Medicare PIN