1760768436 NPI number — JEFFREY T MOLINARO DPM PC

Table of content: (NPI 1760768436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760768436 NPI number — JEFFREY T MOLINARO DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY T MOLINARO DPM PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1760768436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 DIXIE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15071-1516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-787-8380
Provider Business Mailing Address Fax Number:
412-787-8380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 DIXIE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15071-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-787-8380
Provider Business Practice Location Address Fax Number:
412-787-8380
Provider Enumeration Date:
10/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MOLINARO
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-787-8380

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC-003779R , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 489493 . This is a "MEDICARE ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1184618639 . This is a "GROUP NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1392756 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0887895 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1699772822 . This is a "GROUP NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0887896 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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