Provider Demographics
NPI:1437214749
Name:MOGLIA, JOHN L (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:MOGLIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:668 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1056
Mailing Address - Country:US
Mailing Address - Phone:908-464-7977
Mailing Address - Fax:908-464-7745
Practice Address - Street 1:668 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1056
Practice Address - Country:US
Practice Address - Phone:908-464-7977
Practice Address - Fax:908-464-7745
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD001156213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMO442050Medicare PIN
NJT44983Medicare UPIN
NJ4181070001Medicare NSC