Provider Demographics
NPI:1669500492
Name:ABATE BERSALONA, HOLLY (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:ABATE BERSALONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SEA GIRT AVE
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2923
Mailing Address - Country:US
Mailing Address - Phone:732-282-9000
Mailing Address - Fax:732-282-9144
Practice Address - Street 1:511 SEA GIRT AVE
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-2923
Practice Address - Country:US
Practice Address - Phone:732-282-9000
Practice Address - Fax:732-282-9144
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06644800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ045983Medicare PIN
NJ028819PP2Medicare ID - Type Unspecified
NJG99138Medicare UPIN