Provider Demographics
NPI:1457508863
Name:ALBERT C. HOLTZMAN M.D. PC
Entity Type:Organization
Organization Name:ALBERT C. HOLTZMAN M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HOLTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-634-3885
Mailing Address - Street 1:180 PHILLIPS HILL ROAD,
Mailing Address - Street 2:BUILDING #4
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 PHILLIPS HILL ROAD,
Practice Address - Street 2:BUILDING #4
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4132
Practice Address - Country:US
Practice Address - Phone:845-634-3885
Practice Address - Fax:845-634-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090012207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00544014Medicaid
NYB14567Medicare UPIN
NY43298100Medicare PIN