Provider Demographics
NPI:1073602082
Name:HOLTZIN, ROBERT M (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:HOLTZIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:802 TILTON ROAD
Mailing Address - Street 2:#102
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225
Mailing Address - Country:US
Mailing Address - Phone:609-569-1900
Mailing Address - Fax:609-569-1404
Practice Address - Street 1:802 TILTON RD
Practice Address - Street 2:#102
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1233
Practice Address - Country:US
Practice Address - Phone:609-569-1900
Practice Address - Fax:609-569-1404
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB05678600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ503586SBVMedicare PIN
NJ503586PKMMedicare PIN
NJE70595Medicare UPIN
NJ503586QLLMedicare PIN