Provider Demographics
NPI:1497212856
Name:HOLDRIDGE, MARIAN KATZ (RD, CDN)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:KATZ
Last Name:HOLDRIDGE
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EXECUTIVE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-8218
Mailing Address - Country:US
Mailing Address - Phone:845-357-0166
Mailing Address - Fax:845-357-0249
Practice Address - Street 1:2 EXECUTIVE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-8218
Practice Address - Country:US
Practice Address - Phone:845-357-0166
Practice Address - Fax:845-357-0249
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000685-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered