Provider Demographics
NPI:1558563643
Name:MOLLOY, DAFCIK & KULAKOV L.L.C
Entity Type:Organization
Organization Name:MOLLOY, DAFCIK & KULAKOV L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:203-255-0695
Mailing Address - Street 1:134 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5166
Mailing Address - Country:US
Mailing Address - Phone:203-255-0695
Mailing Address - Fax:203-255-0629
Practice Address - Street 1:134 ROUND HILL RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5166
Practice Address - Country:US
Practice Address - Phone:203-255-0695
Practice Address - Fax:203-255-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02222Medicare PIN