Provider Demographics
NPI:1508017492
Name:HOLLYWOOD, ADRIENNE M (OTR)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:M
Last Name:HOLLYWOOD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:M
Other - Last Name:DURSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1236 SUSSEX TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1236 SUSSEX TURNPIKE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-219-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00300700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist