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General NPI Number Information
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NPI Number | 1962613091
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Entity Type | Individual
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Provider Name | ROBERT CARL MOLLICA MS OTR
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 188 NEWARK POMPTON TPKE
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City | LITTLE FALLS
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State | NJ
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Zip | 07424-1112
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Country | US
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Telephone | 877-887-3574
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Fax | 862-279-7580
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Provider Business Mailing Address
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Address Line | 329 GILBERT ST APARTMENT A
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-5105
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Country | US
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Telephone | 201-468-3488
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 46TR00395200
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License Number State | NJ
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