Provider Demographics
NPI:1720165392
Name:MOLESKY, WILLIAM GERALD (DC, FIAMA)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GERALD
Last Name:MOLESKY
Suffix:
Gender:M
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VIA LUGANO CIR
Mailing Address - Street 2:# 209
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7161
Mailing Address - Country:US
Mailing Address - Phone:954-547-5877
Mailing Address - Fax:
Practice Address - Street 1:15300 JOG RD
Practice Address - Street 2:SUITE 107,108
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2162
Practice Address - Country:US
Practice Address - Phone:561-742-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62774OtherBC&BS PROVIDER
FL6556693OtherCIGNA
FLGX571ZMedicare UPIN