Provider Demographics
NPI:1659459600
Name:MOLINE, JANET (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:MOLINE
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 1:25 CORTLANDT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2005
Mailing Address - Country:US
Mailing Address - Phone:914-632-1834
Mailing Address - Fax:
Practice Address - Street 1:1 FORDHAM PLZ
Practice Address - Street 2:SUITE 232
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5871
Practice Address - Country:US
Practice Address - Phone:718-365-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1650222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG65889Medicare UPIN
NY57M511Medicare ID - Type Unspecified