Provider Demographics
NPI:1790732451
Name:HOLLIDAY, ROY A (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:A
Last Name:HOLLIDAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 GUSTAVE L. LEVY PLACE
Mailing Address - Street 2:BOX 1194
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-8395
Mailing Address - Fax:212-289-0092
Practice Address - Street 1:310 EAST 14TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-979-4400
Practice Address - Fax:212-590-2982
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2015-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1567982085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64559Medicare UPIN
NY01905848Medicare ID - Type Unspecified
NY86D211Medicare ID - Type Unspecified