Provider Demographics
NPI:1790809929
Name:MOLLOY, PAULINE (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:MRS
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:MOLLOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:129 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-4161
Mailing Address - Country:US
Mailing Address - Phone:516-385-5856
Mailing Address - Fax:
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant