Provider Demographics
NPI:1609661537
Name:MOLINA MEDCO CORP
Entity type:Organization
Organization Name:MOLINA MEDCO CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONIN AMAURY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA BATISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-615-4754
Mailing Address - Street 1:971 US HIGHWAY 202 N STE A
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3757
Mailing Address - Country:US
Mailing Address - Phone:315-615-4754
Mailing Address - Fax:315-615-4771
Practice Address - Street 1:971 US HIGHWAY 202 N STE A
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3757
Practice Address - Country:US
Practice Address - Phone:315-615-4754
Practice Address - Fax:315-615-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies