Provider Demographics
NPI:1558608471
Name:MOLL, KAREN LIN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LIN
Last Name:MOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FAIRFIELD AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2153
Mailing Address - Country:US
Mailing Address - Phone:716-432-4688
Mailing Address - Fax:
Practice Address - Street 1:4 FAIRFIELD AVE
Practice Address - Street 2:APT 1
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2153
Practice Address - Country:US
Practice Address - Phone:716-432-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152283174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist