Provider Demographics
NPI:1023006517
Name:MOLLE, ROBERT E (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:MOLLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 35TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4702
Mailing Address - Country:US
Mailing Address - Phone:718-278-1919
Mailing Address - Fax:718-278-7516
Practice Address - Street 1:3066 35TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4702
Practice Address - Country:US
Practice Address - Phone:718-278-1919
Practice Address - Fax:718-278-7516
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096186207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DS518OtherOXFORD
905022OtherBC
NY01689436Medicaid
NY01689436Medicaid
B79769Medicare UPIN