Basic Information
| Provider Information | |||||||||
| NPI: | 1164571691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLTZMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 9019 | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118029019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164423461 | ||||||||
| FaxNumber: | 5164423462 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MERRICK ROAD | ||||||||
| Address2: | SUITE 128W | ||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115704821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162559031 | ||||||||
| FaxNumber: | 5162556010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 05/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 106542 | NY | Y | Other Service Providers | Specialist |
No ID Information.