Provider Demographics
NPI:1164571691
Name:HOLTZMAN, ROBERT N (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:HOLTZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 9019
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11802-9019
Mailing Address - Country:US
Mailing Address - Phone:516-442-3461
Mailing Address - Fax:516-442-3462
Practice Address - Street 1:100 MERRICK ROAD
Practice Address - Street 2:SUITE 128W
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4821
Practice Address - Country:US
Practice Address - Phone:516-255-9031
Practice Address - Fax:516-255-6010
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY32E081Medicare UPIN
NYB12953Medicare UPIN
NY32E081Medicare PIN