Healthcare Provider Details

I. General information

NPI: 1396702643
Provider Name (Legal Business Name): MING MING MOLONY LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BRIDGE ST
CATASAUQUA PA
18032-2506
US

IV. Provider business mailing address

101 BRIDGE ST
CATASAUQUA PA
18032-2506
US

V. Phone/Fax

Practice location:
  • Phone: 610-264-2755
  • Fax: 610-264-7292
Mailing address:
  • Phone: 610-264-2755
  • Fax: 610-264-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK000157L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: