Provider Demographics
NPI:1407238256
Name:HOLADAY, LOUISA
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:
Last Name:HOLADAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CABRINI BLVD
Mailing Address - Street 2:APT 74
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1100
Mailing Address - Country:US
Mailing Address - Phone:646-229-2825
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-241-4141
Practice Address - Fax:212-426-5018
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-28
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine