MEDICARE: ADIRONDACK ELITE AESTHETICS PLLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1205787785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADIRONDACK ELITE AESTHETICS PLLC

Provider Business Mailing Address
First Line	:	5111 N CATHERINE ST
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-3379
Country	:	US
Telephone Number	:	518-420-8597
Fax Number	:	518-665-3346

Provider Business Practice Location Address
First Line	:	5111 N CATHERINE ST
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-3379
Country	:	US
Telephone Number	:	518-420-8597
Fax Number	:	518-665-3346

Authorized Official
Title or Position	:	OWNER
Name	:	BRIDGET A MOLLOY
Credential	:	NP
Telephone Number	:	518-420-8597

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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