Healthcare Provider Details

I. General information

NPI: 1770953861
Provider Name (Legal Business Name): MOLLY JEAN HORNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MOLLY JEAN LONG

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 WEST AVE FL 2
BROCKPORT NY
14420-1229
US

IV. Provider business mailing address

601 ELMWOOD AVENUE BOX 668
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-758-7557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060497
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19179
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number019179
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: