Provider Demographics
NPI:1942252903
Name:MOLLICA, RAYMOND J (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:MOLLICA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3113
Mailing Address - Country:US
Mailing Address - Phone:718-236-2871
Mailing Address - Fax:718-331-4122
Practice Address - Street 1:8223 14TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3113
Practice Address - Country:US
Practice Address - Phone:718-236-2871
Practice Address - Fax:718-331-4122
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003020213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00486580Medicaid
NY18656OtherGHI PROVIDER NUMBER
3C0207OtherHEALTHNET ID NUMBER
NYP2174717OtherOXFORD ID NUMBER
0000619-02OtherAMERICHOICE
N003020-B16OtherHEALTHFIRST
000294640101OtherHEALTH PLUS ID NUMBER
BCBSOtherP3256
11163175917OtherTOUCHSTONE
442480053OtherRAIDROAD MEDICARE NUMBER
NY163193OtherELDERPLAN PROVIDER NUMBER
36621POtherHIP PRIS # PRIMARY OFFICE
50026POtherHIP PRIS #- SECOND OFFICE
NY18656OtherGHI PROVIDER NUMBER
000294640101OtherHEALTH PLUS ID NUMBER
NY163193OtherELDERPLAN PROVIDER NUMBER