Provider Demographics
NPI:1558706564
Name:FOOTE, HOLLY CHRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:CHRISTINE
Last Name:FOOTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 EDGEWATER TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2222
Mailing Address - Country:US
Mailing Address - Phone:405-795-8291
Mailing Address - Fax:
Practice Address - Street 1:326 EDGEWATER TOWNE CTR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-2222
Practice Address - Country:US
Practice Address - Phone:405-795-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272882208600000X
NY272882-1208600000X
NJ25MB09608600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery