Provider Demographics
NPI:1508112384
Name:DR. MICHEL AND NICOLE MOULIN
Entity Type:Organization
Organization Name:DR. MICHEL AND NICOLE MOULIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOULIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-832-0050
Mailing Address - Street 1:210 E - 47TH
Mailing Address - Street 2:#1C
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2104
Mailing Address - Country:US
Mailing Address - Phone:212-832-0550
Mailing Address - Fax:212-829-7002
Practice Address - Street 1:210 E - 47TH
Practice Address - Street 2:#1C
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10017-2104
Practice Address - Country:US
Practice Address - Phone:212-832-0550
Practice Address - Fax:212-829-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134945207W00000X, 208D00000X
NY143416207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty