Healthcare Provider Details

I. General information

NPI: 1881078970
Provider Name (Legal Business Name): MICHAEL ANDREW MOLITORIS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WESCOTT DR STE 303
FLEMINGTON NJ
08822-4600
US

IV. Provider business mailing address

1100 WESCOTT DR STE 303
FLEMINGTON NJ
08822-4600
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6449
  • Fax: 908-788-6668
Mailing address:
  • Phone: 908-788-6449
  • Fax: 908-788-6668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006688
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00342700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: