Provider Demographics
NPI:1184846925
Name:HOLDER, GRACE DENIZ GEM (PA C)
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:DENIZ GEM
Last Name:HOLDER
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Gender:F
Credentials:PA C
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Mailing Address - Street 1:1 BROOKDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-6662
Mailing Address - Fax:718-240-5071
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY #13CHC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-6092
Practice Address - Fax:718-240-5071
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-08-30
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Provider Licenses
StateLicense IDTaxonomies
NY0027331363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant