Provider Demographics
NPI:1861703605
Name:UMDNJ-SOM
Entity type:Organization
Organization Name:UMDNJ-SOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGIL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-566-6708
Mailing Address - Street 1:147 WHITE CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-3424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:147 WHITE CEDAR DR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-3424
Practice Address - Country:US
Practice Address - Phone:570-436-2471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-26
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital