Healthcare Provider Details

I. General information

NPI: 1033419965
Provider Name (Legal Business Name): JOSEPH A MOLINARO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 SNELLING AVE N 265
ROSEVILLE MN
55113-1876
US

IV. Provider business mailing address

2680 SNELLING AVE N 265
ROSEVILLE MN
55113-1876
US

V. Phone/Fax

Practice location:
  • Phone: 651-600-3245
  • Fax: 651-600-3182
Mailing address:
  • Phone: 651-600-3245
  • Fax: 651-600-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2693
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: