Provider Demographics
NPI:1073623922
Name:MOLOCHNICK, JOANNE (ATCRL)
Entity Type:Individual
Prefix:MISS
First Name:JOANNE
Middle Name:
Last Name:MOLOCHNICK
Suffix:
Gender:F
Credentials:ATCRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 AYLIN ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1226
Mailing Address - Country:US
Mailing Address - Phone:732-548-0231
Mailing Address - Fax:
Practice Address - Street 1:1100 BROOKS BLVD
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1542
Practice Address - Country:US
Practice Address - Phone:908-231-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT0002340002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22OtherA.T.C.R