Provider Demographics
NPI:1427543131
Name:LANGE, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:FEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCTMB
Mailing Address - Street 1:376 VAN HOLTEN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1946
Mailing Address - Country:US
Mailing Address - Phone:908-655-6926
Mailing Address - Fax:
Practice Address - Street 1:1 LAMINGTON RD
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3374
Practice Address - Country:US
Practice Address - Phone:908-655-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00203500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist