Provider Demographics
NPI:1710194246
Name:HOLZER, BARRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:D
Last Name:HOLZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13718 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1962
Mailing Address - Country:US
Mailing Address - Phone:718-544-7912
Mailing Address - Fax:718-743-7630
Practice Address - Street 1:13718 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1962
Practice Address - Country:US
Practice Address - Phone:718-544-7912
Practice Address - Fax:718-743-7630
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162654-12084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051885OtherGHI CLAIMS
NYE57628Medicare UPIN