Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 190247 | NY |
NPI | 1003908831 |
---|---|
Provider Name | Dr. Leanne Mary Molia |
First Address | Port Jefferson Station, NY 11776-1597 |
Second Address | Port Jefferson Station, NY 11776-1597 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 13/07/2007 |