Provider Demographics
NPI:1427017235
Name:MOLINA, MARIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:M
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7404
Mailing Address - Country:US
Mailing Address - Phone:212-283-6100
Mailing Address - Fax:212-283-6111
Practice Address - Street 1:3421 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7404
Practice Address - Country:US
Practice Address - Phone:212-283-6100
Practice Address - Fax:212-283-6111
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2144402080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01960970Medicaid
NYH00613Medicare UPIN
NY657X41Medicare ID - Type Unspecified