Provider Demographics
NPI:1881847051
Name:MICHAEL S. BUCHHOLTZ, MD PC
Entity Type:Organization
Organization Name:MICHAEL S. BUCHHOLTZ, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-427-1938
Mailing Address - Street 1:270 PULASKI RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1605
Mailing Address - Country:US
Mailing Address - Phone:631-427-6060
Mailing Address - Fax:631-427-2040
Practice Address - Street 1:270 PULASKI RD
Practice Address - Street 2:SUITE D
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1605
Practice Address - Country:US
Practice Address - Phone:631-427-6060
Practice Address - Fax:631-427-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01568890Medicaid
NY01568890Medicaid
4345870001Medicare NSC