Provider Demographics
NPI:1265452221
Name:MOLINO, BRUNO (MD)
Entity Type:Individual
Prefix:
First Name:BRUNO
Middle Name:
Last Name:MOLINO
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:JERSEY CITY MEDICAL CENTER, DEPT. OF SURGERY
Mailing Address - Street 2:355 GRAND STREET
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-915-2451
Mailing Address - Fax:201-915-2192
Practice Address - Street 1:JERSEY CITY MEDICAL CENTER, DEPT. OF SURGERY
Practice Address - Street 2:355 GRAND STREET
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-915-2451
Practice Address - Fax:201-915-2192
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA694842086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
090818H42Medicare ID - Type Unspecified
I29212Medicare UPIN