Provider Demographics
NPI:1962675132
Name:MOGILA, FAITH MARLENE (SCD)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:MARLENE
Last Name:MOGILA
Suffix:
Gender:F
Credentials:SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 ALDEBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4869
Mailing Address - Country:US
Mailing Address - Phone:732-302-0039
Mailing Address - Fax:
Practice Address - Street 1:37 CLYDE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5034
Practice Address - Country:US
Practice Address - Phone:732-873-6863
Practice Address - Fax:732-873-6853
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ719231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist