Basic Information
| Provider Information | |||||||||
| NPI: | 1598005175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLLETTE | ||||||||
| FirstName: | ARABIA | ||||||||
| MiddleName: | DIVINE | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MOLLETTE | ||||||||
| OtherFirstName: | ARABIA | ||||||||
| OtherMiddleName: | DEVINE | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 760 BROADWAY | ||||||||
| Address2: | DEPARTMENT OF MANAGED CARE, ROOM 2B-230 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112065317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186303020 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 LYONS AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071122027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739266671 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2013 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 281186-1 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.