Provider Demographics
NPI:1033287354
Name:MOLLICA, ANTHONY SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:SCOTT
Last Name:MOLLICA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 VON HUENFELD ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2254
Mailing Address - Country:US
Mailing Address - Phone:516-541-2005
Mailing Address - Fax:
Practice Address - Street 1:200 OLD SUNRISE HWY
Practice Address - Street 2:SUITE #2
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5545
Practice Address - Country:US
Practice Address - Phone:516-541-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8851-0111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXOA291Medicare ID - Type Unspecified
NYU69337Medicare UPIN