Provider Demographics
NPI:1225011331
Name:ADANIEL, MOLAVE AGANA (MD)
Entity type:Individual
Prefix:DR
First Name:MOLAVE
Middle Name:AGANA
Last Name:ADANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:510 MONTAUK HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-587-1451
Mailing Address - Fax:631-587-0503
Practice Address - Street 1:510 MONTAUK HWY
Practice Address - Street 2:SUITE C
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4422
Practice Address - Country:US
Practice Address - Phone:631-587-1451
Practice Address - Fax:631-587-0503
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY111104208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB20443Medicare UPIN
NY959951Medicare ID - Type Unspecified