Provider Demographics
NPI:1053623595
Name:SANDRA MOLOCZNIK MD PA
Entity type:Organization
Organization Name:SANDRA MOLOCZNIK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOLOCZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-345-1516
Mailing Address - Street 1:3363 NE 163RD ST
Mailing Address - Street 2:SUITE 809
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4401
Mailing Address - Country:US
Mailing Address - Phone:786-345-1516
Mailing Address - Fax:786-513-2617
Practice Address - Street 1:3363 NE 163RD ST
Practice Address - Street 2:SUITE 809
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4401
Practice Address - Country:US
Practice Address - Phone:786-345-1516
Practice Address - Fax:786-513-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty