Provider Demographics
NPI:1316584071
Name:MOLINET, CHRISTOPHER JACOB
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JACOB
Last Name:MOLINET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LIDO BLVD APT 1A
Mailing Address - Street 2:
Mailing Address - City:POINT LOOKOUT
Mailing Address - State:NY
Mailing Address - Zip Code:11569-3021
Mailing Address - Country:US
Mailing Address - Phone:516-512-0834
Mailing Address - Fax:
Practice Address - Street 1:3 LIDO BLVD # 1A
Practice Address - Street 2:
Practice Address - City:POINT LOOKOUT
Practice Address - State:NY
Practice Address - Zip Code:11569-3021
Practice Address - Country:US
Practice Address - Phone:516-512-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031776225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist