Provider Demographics
NPI:1477084697
Name:MOLINA, NATHAN DUDLEY (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:DUDLEY
Last Name:MOLINA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENT AVE STE 605
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-4357
Mailing Address - Country:US
Mailing Address - Phone:718-208-4577
Mailing Address - Fax:
Practice Address - Street 1:300 KENT AVE STE 605
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-4357
Practice Address - Country:US
Practice Address - Phone:718-208-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3168492086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery