Provider Demographics
NPI:1629406152
Name:HOLMAN, ONIKA AYANNA (NP)
Entity Type:Individual
Prefix:
First Name:ONIKA
Middle Name:AYANNA
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LONG ISLAND CONSULTATION CENTER
Mailing Address - Street 2:91-31 QUEENS BLVD
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-896-3400
Mailing Address - Fax:
Practice Address - Street 1:424 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4901
Practice Address - Country:US
Practice Address - Phone:212-263-4617
Practice Address - Fax:212-263-1051
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404543363LP0808X
NY430747363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY404543OtherNY PSYCHIATRY LICENCE