Healthcare Provider Details

I. General information

NPI: 1073824702
Provider Name (Legal Business Name): MOLLY MARIE SCHULTHEIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST
ENGLEWOOD NJ
07631-1808
US

IV. Provider business mailing address

1 MELROSE TER APT 116
LONG BRANCH NJ
07740-8126
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3636
  • Fax:
Mailing address:
  • Phone: 518-469-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number25MA09669400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: