Individual
DR. GLEN RAYMOND MOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 S ORANGE AVE, SUITE 128, LIVINGSTON, NJ 07039-5817
(973) 322-7755
(973) 322-7764
Mailing address
200 S ORANGE AVE, SUITE 128, LIVINGSTON, NJ 07039-5817
(973) 322-7755
(973) 322-7764
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
25MA037333
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0355607
—
NJ
Enumeration date
03/01/2006
Last updated
04/05/2017
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