Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 125573 | NY |
NPI | 1083698765 |
---|---|
Provider Name | Dr. Lawrence B Mollick |
First Address | Great Neck, NY 11021-5100 |
Second Address | Great Neck, NY 11021-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A96461 | (02) | NY |