Healthcare Provider Details

I. General information

NPI: 1104189992
Provider Name (Legal Business Name): MOLAIN SAINTILUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 QUARRY RD SUITE 220
TRUMBULL CT
06611-4848
US

IV. Provider business mailing address

1 RICHLEE CT APARTMENT 2S
MINEOLA NY
11501-3619
US

V. Phone/Fax

Practice location:
  • Phone: 203-374-6162
  • Fax: 203-374-1549
Mailing address:
  • Phone: 347-255-6026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number719291062
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number054098
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: