MEDICARE: DR. PETER W MOLLICA D.P.M

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	213E00000X	Podiatrist	N003105	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285683508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER W MOLLICA D.P.M

Provider Business Mailing Address
First Line	:	8223 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3113
Country	:	US
Telephone Number	:	718-236-4231
Fax Number	:	718-852-9155

Provider Business Practice Location Address
First Line	:	8223 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3113
Country	:	US
Telephone Number	:	718-236-4231
Fax Number	:	718-852-9155

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	02/20/2008

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