Individual provider Active NPI

Lawrence B Mollick, M.D.

  • Otolaryngology Physician
  • Great Neck, NY
National Provider Identifier
1083698765
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
125573 Issued in NY
Practice address
560 Northern Blvd
Great Neck, NY 11021-5100
Phone
(516) 487-6200
Fax
(516) 487-6329
NPI assigned
Dec 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 125573 NY Primary

Addresses

Primary practice location

560 Northern Blvd
Great Neck, NY 11021-5100

Mailing address

560 Northern Blvd
Great Neck, NY 11021-5100
Phone (516) 487-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041014000463 NY Practitioner - Otolaryngology 8628038650

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125573NYMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mollick Etra Etra & Cohen Otolaryngology CurrentSince Apr 2, 2007 Accepting new patients

Locations

560 Northern Blvd
Great Neck, NY 11021
Phone (516) 466-6165

5505 Route 347
Mount Sinai, NY 11766
Phone (631) 331-4403

175 Jericho Tpke
Syosset, NY 11791
Phone (516) 364-8780

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1083698765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 NORTHERN BLVD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215100",
            "telephone_number": "516-487-6200",
            "fax_number": "516-487-6329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 NORTHERN BLVD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215100",
            "telephone_number": "516-487-6200",
            "fax_number": "516-487-6329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLICK",
        "first_name": "LAWRENCE",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "125573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.