Healthcare Provider Details

I. General information

NPI: 1922488980
Provider Name (Legal Business Name): MOLLIE ROSE FREEDMAN-WEISS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CEDAR ST YNHH, DEPARTMENT OF SURGERY
NEW HAVEN CT
06510-3218
US

IV. Provider business mailing address

525 E 68TH ST # 209
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-5479
  • Fax:
Mailing address:
  • Phone: 646-962-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number331986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: