Provider Demographics
NPI:1275626400
Name:SOLOMON, MOLHAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:MOLHAM
Middle Name:M
Last Name:SOLOMON
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 1:320 STOBE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5236
Mailing Address - Country:US
Mailing Address - Phone:718-979-9801
Mailing Address - Fax:
Practice Address - Street 1:8906 135TH ST
Practice Address - Street 2:SUITE 6S
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2828
Practice Address - Country:US
Practice Address - Phone:718-206-6708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206393207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02194970Medicaid
NYH48480Medicare UPIN
NY02194970Medicaid