Healthcare Provider Details

I. General information

NPI: 1750174462
Provider Name (Legal Business Name): MELANIE MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MOUNT OLIVE RD
FLANDERS NJ
07836-9725
US

IV. Provider business mailing address

117 MOUNT OLIVE RD
FLANDERS NJ
07836-9725
US

V. Phone/Fax

Practice location:
  • Phone: 862-812-0617
  • Fax:
Mailing address:
  • Phone: 862-812-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: