Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 096186 | NY |
NPI | 1023006517 |
---|---|
Provider Name | Mr. Robert E Molle |
First Address | Astoria, NY 11103-4702 |
Second Address | Astoria, NY 11103-4702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 16/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01689436 | (05) | NY |
905022 | BC (01) | |
B79769 | (02) | |
DS518 | OXFORD (01) |