Provider Demographics
NPI:1659379121
Name:MOLINO, DANTE C (CPO)
Entity Type:Individual
Prefix:MR
First Name:DANTE
Middle Name:C
Last Name:MOLINO
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1911
Mailing Address - Country:US
Mailing Address - Phone:570-283-3835
Mailing Address - Fax:579-283-3805
Practice Address - Street 1:300 AVENUE A
Practice Address - Street 2:
Practice Address - City:SWOYERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-1911
Practice Address - Country:US
Practice Address - Phone:570-283-3835
Practice Address - Fax:579-283-3805
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011636190003Medicaid
206119OtherBLUE CROSS
44592OtherGEISINGER HP
206119OtherBLUE CROSS