Individual provider Active NPI

Molly Vallon, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1114299930
Registry record updated Dec 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
015456-1 Issued in NY
Practice address
520 E 70TH St # 341
New York, NY 10021-9800
Phone
(212) 746-7576
NPI assigned
Feb 9, 2012
Last updated
Dec 9, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 015456-1 NY Primary

Addresses

Primary practice location

520 E 70TH St # 341
New York, NY 10021-9800

Mailing address

575 Lexington Ave
New York, NY 10022-6102
Phone (212) 746-7576

Other identifiers 2

IdentifierTypeStateIssuer
1103150.OtherNYNCCPA
015456-1OtherNYNY STATE LICENSE

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160311002162 NY Practitioner - Physician Assistant 4880990159 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
015456NYMDClinical Neuropsychologist
015456-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Weill Medical College of Cornell CurrentSince Dec 28, 2015 Accepting new patients
Weill Medical College of Cornell CurrentSince Dec 28, 2015 Accepting new patients
Weill Medical College of Cornell Past Accepting new patients

Locations

520 E 70th St
New York, NY 10021
Phone (212) 746-0838

520 E 70th St
#341
New York, NY 10021
Phone (212) 746-7576

520 E 70th St
Ste 341
New York, NY 10021
Phone (212) 746-2087

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

525 E 68th St
#M
New York, NY 10065
Phone (212) 746-2850

Interoperability endpoints

  • Direct secure messaging: mov9008@direct.nyp.org

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449619200000",
    "number": "1114299930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 LEXINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100226102",
            "telephone_number": "212-746-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E 70TH ST # 341",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100219800",
            "telephone_number": "212-746-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLON",
        "first_name": "MOLLY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-09",
        "last_updated": "2015-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015456-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1103150.",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE LICENSE",
            "identifier": "015456-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.