Provider Demographics
NPI:1164990503
Name:MOLINA, DORA
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DORA
Other - Middle Name:
Other - Last Name:PRIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1912
Mailing Address - Country:US
Mailing Address - Phone:973-896-8130
Mailing Address - Fax:
Practice Address - Street 1:40 CENTER ST
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1912
Practice Address - Country:US
Practice Address - Phone:973-896-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-04
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NH09903800376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker