Provider Demographics
NPI:1598418253
Name:HOLLIDAY, JUSTIN DION
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DION
Last Name:HOLLIDAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VARICK ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4810
Mailing Address - Country:US
Mailing Address - Phone:212-620-0340
Mailing Address - Fax:212-533-8403
Practice Address - Street 1:8 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8908
Practice Address - Country:US
Practice Address - Phone:212-533-8400
Practice Address - Fax:212-533-8403
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073183164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse