1891799771 NPI number — MITCHELL VOGEL M.D.

Table of content: MITCHELL VOGEL M.D. (NPI 1891799771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891799771 NPI number — MITCHELL VOGEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOGEL
Provider First Name:
MITCHELL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891799771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1455 BROAD ST STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07003-3039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-779-0808
Provider Business Mailing Address Fax Number:
973-471-1929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1455 BROAD ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07003-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-779-0808
Provider Business Practice Location Address Fax Number:
973-471-1929
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  25MA06370000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 223589980 . This is a "IDA ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223589980 . This is a "MAIL HANDLERS PLAN ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180033572 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223589980 . This is a "AARP ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1094006 . This is a "OXFORD ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1051800 . This is a "AETNA IND PROV NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223589980 . This is a "FIRST HEALTH ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 96T25 . This is a "EMPIRE BLUE CROSS ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223589980 . This is a "PHCS ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7650809 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223589980 . This is a "NALC ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223589980 . This is a "CORESOURCE ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: OK8636 . This is a "HEALTH NET ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0656338 . This is a "CIGNA PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1816887 . This is a "UNITED HEALTHCARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223589980 . This is a "HORIZON BCBSNJ ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223589980 . This is a "BEECH STREET ID NUMBER" identifier . This identifiers is of the category "OTHER".




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