Provider Demographics
NPI:1184640773
Name:MOLINA-MARINEZ, JAIME L (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:MOLINA-MARINEZ
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 1:111 CLARA BARTON ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9503
Mailing Address - Country:US
Mailing Address - Phone:585-335-6001
Mailing Address - Fax:585-335-9728
Practice Address - Street 1:111 CLARA BARTON ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9503
Practice Address - Country:US
Practice Address - Phone:585-335-6001
Practice Address - Fax:585-335-9728
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07804100207RC0200X
PAMD443992207RC0200X, 207RP1001X
CT044559207RC0200X
NY282931207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0097748Medicaid
MS01905575Medicaid
NJ247313YBAWMedicare PIN
NJ0097748Medicaid