Provider Demographics
NPI:1417271768
Name:NERI HOLZER, MD PC
Entity Type:Organization
Organization Name:NERI HOLZER, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-928-7793
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-0514
Mailing Address - Country:US
Mailing Address - Phone:860-928-7793
Mailing Address - Fax:860-928-9760
Practice Address - Street 1:19 QUINEBAUG AVE
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1943
Practice Address - Country:US
Practice Address - Phone:860-928-7793
Practice Address - Fax:860-928-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021027261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004095221Medicaid
CTA67663Medicare UPIN