Provider Demographics
NPI:1003908831
Name:MOLIA, LEANNE MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:MARY
Last Name:MOLIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MEDICAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1597
Mailing Address - Country:US
Mailing Address - Phone:631-331-1966
Mailing Address - Fax:
Practice Address - Street 1:3 MEDICAL DR STE B
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1597
Practice Address - Country:US
Practice Address - Phone:631-331-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190247207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92T131Medicare ID - Type Unspecified