Provider Demographics
NPI:1295067007
Name:MOGUL, JASON ANDREW
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:MOGUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3009
Mailing Address - Country:US
Mailing Address - Phone:201-837-1552
Mailing Address - Fax:
Practice Address - Street 1:249 CHURCHILL RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3009
Practice Address - Country:US
Practice Address - Phone:201-837-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012851-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist