Provider Demographics
NPI:1962613091
Name:MOLLICA, ROBERT CARL (MS OTR)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CARL
Last Name:MOLLICA
Suffix:
Gender:M
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 GILBERT ST
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5105
Mailing Address - Country:US
Mailing Address - Phone:201-468-3488
Mailing Address - Fax:
Practice Address - Street 1:188 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1112
Practice Address - Country:US
Practice Address - Phone:877-887-3574
Practice Address - Fax:862-279-7580
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00395200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist