Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1659379121 |
---|---|
Provider Name | Mr. Dante C. Molino |
First Address | Swoyersville, PA 18704-1911 |
Second Address | Swoyersville, PA 18704-1911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011636190003 | (05) | PA |
206119 | BLUE CROSS (01) | |
44592 | GEISINGER HP (01) |