Healthcare Provider Details

I. General information

NPI: 1659932929
Provider Name (Legal Business Name): MOLLY MCEVOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ORANGE AVE STE 230
LIVINGSTON NJ
07039-5817
US

IV. Provider business mailing address

10 1ST AVE
EAST ORANGE NJ
07017-5423
US

V. Phone/Fax

Practice location:
  • Phone: 201-716-5850
  • Fax:
Mailing address:
  • Phone: 919-628-5664
  • 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: