Organization
ADVANCED GASTROENTEROLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN R MOGAN MD (OWNER)
(973) 731-8686
Entity
Organization
Contact information
Practice address
741 NORTHFIELD AVENUE, SUITE 204, WEST ORANGE, NJ 07052
(973) 731-8686
(973) 731-1911
Mailing address
741 NORTHFIELD AVENUE, SUITE 204, WEST ORANGE, NJ 07052
(973) 731-8686
(973) 731-1911
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
25MA037333
NJ
Other
Enumeration date
09/08/2010
Last updated
09/08/2010
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