Healthcare Provider Details

I. General information

NPI: 1073623922
Provider Name (Legal Business Name): JOANNE MOLOCHNICK A.T.C.R.L.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BROOKS BLVD
MANVILLE NJ
08835-1542
US

IV. Provider business mailing address

82 AYLIN ST
METUCHEN NJ
08840-1226
US

V. Phone/Fax

Practice location:
  • Phone: 908-231-8505
  • Fax:
Mailing address:
  • Phone: 732-548-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT000234000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: