Provider Demographics
NPI:1295069003
Name:DR JOHN R MORDAGA PC
Entity type:Organization
Organization Name:DR JOHN R MORDAGA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORDAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-772-1004
Mailing Address - Street 1:385 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-4074
Mailing Address - Country:US
Mailing Address - Phone:973-772-1004
Mailing Address - Fax:973-772-9504
Practice Address - Street 1:385 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4074
Practice Address - Country:US
Practice Address - Phone:973-772-1004
Practice Address - Fax:973-772-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M619484Medicare PIN