MEDICARE: DR. RAYMOND J 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	213ES0103X	Foot & Ankle Surgery Podiatrist	N003020	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	442480053	OTHER		RAIDROAD MEDICARE NUMBER

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
2	18656	OTHER	NY	GHI PROVIDER NUMBER
3	3C0207	OTHER		HEALTHNET ID NUMBER
4	P2174717	OTHER	NY	OXFORD ID NUMBER
5	0000619-02	OTHER		AMERICHOICE
6	N003020-B16	OTHER		HEALTHFIRST
7	000294640101	OTHER		HEALTH PLUS ID NUMBER
8	BCBS	OTHER		P3256
9	11163175917	OTHER		TOUCHSTONE
11	163193	OTHER	NY	ELDERPLAN PROVIDER NUMBER
12	36621P	OTHER		HIP PRIS # PRIMARY OFFICE
13	50026P	OTHER		HIP PRIS #- SECOND OFFICE

General Provider Information

NPI Number	:	1942252903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND J 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	:	718-236-2871
Fax Number	:	718-331-4122

Provider Business Practice Location Address
First Line	:	8223 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3113
Country	:	US
Telephone Number	:	718-236-2871
Fax Number	:	718-331-4122

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/11/2010

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