MEDICARE: JOSE A MOLANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1023581121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE A MOLANO

Provider Business Mailing Address
First Line	:	5 MINERVA PL APT 6H
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-1627
Country	:	US
Telephone Number	:	646-245-3445
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 MINERVA PL APT 6H
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-1627
Country	:	US
Telephone Number	:	646-245-3445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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Directions to “ JOSE A MOLANO ” Practice Location

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