Provider Demographics
NPI:1376680066
Name:IAN J. MOLK, M.D., L.L.C
Entity Type:Organization
Organization Name:IAN J. MOLK, M.D., L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-287-2888
Mailing Address - Street 1:4 ETHEL RD
Mailing Address - Street 2:SUITE 406A
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2841
Mailing Address - Country:US
Mailing Address - Phone:732-287-2888
Mailing Address - Fax:732-287-1176
Practice Address - Street 1:4 ETHEL RD
Practice Address - Street 2:SUITE 406A
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2841
Practice Address - Country:US
Practice Address - Phone:732-287-2888
Practice Address - Fax:732-287-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0462510207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty