MEDICARE: NATHAN MOLINA MD 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	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1821774407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATHAN MOLINA MD PLLC

Provider Business Mailing Address
First Line	:	247 GRAND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-4302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 GRAND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-4302
Country	:	US
Telephone Number	:	860-857-3284
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NATHAN MOLINA
Credential	:	MD
Telephone Number	:	718-208-4577

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	08/31/2023

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