Provider Demographics
NPI:1861816290
Name:BRUCE MOLINELLI MD LLC
Entity Type:Organization
Organization Name:BRUCE MOLINELLI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-742-1173
Mailing Address - Street 1:31 RIVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2152
Mailing Address - Country:US
Mailing Address - Phone:203-742-1173
Mailing Address - Fax:203-489-3411
Practice Address - Street 1:31 RIVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2152
Practice Address - Country:US
Practice Address - Phone:203-742-1173
Practice Address - Fax:203-489-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty