Provider Demographics
NPI:1104845916
Name:MOLITOR, JEROME ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ANTHONY
Last Name:MOLITOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 CIVIC CENTER PLZ
Mailing Address - Street 2:104
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2498
Mailing Address - Country:US
Mailing Address - Phone:845-471-5519
Mailing Address - Fax:845-471-2928
Practice Address - Street 1:155 CRYSTAL RUN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4028
Practice Address - Country:US
Practice Address - Phone:845-703-6999
Practice Address - Fax:845-703-2023
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA416192085R0202X, 2085U0001X
NY246993-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3694607Medicaid
NY32R42R8362Medicare PIN
NY32R42R8363Medicare PIN
NJ3694607Medicaid
NYA400023022Medicare PIN
NY32R42R8361Medicare PIN