Provider Demographics
NPI:1447018361
Name:MOGAKA, PHANE M
Entity type:Individual
Prefix:
First Name:PHANE
Middle Name:M
Last Name:MOGAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:BYRAM TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-3963
Mailing Address - Country:US
Mailing Address - Phone:973-452-0185
Mailing Address - Fax:
Practice Address - Street 1:7 BIRCH RD
Practice Address - Street 2:
Practice Address - City:BYRAM TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07821-3963
Practice Address - Country:US
Practice Address - Phone:973-452-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR248810163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health