Provider Demographics
NPI:1942627443
Name:HOLZER, NAOMI
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:HOLZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 GREYSTONE AVENUE
Mailing Address - Street 2:SUITE 42A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1935
Mailing Address - Country:US
Mailing Address - Phone:917-597-7400
Mailing Address - Fax:
Practice Address - Street 1:3900 GREYSTONE AVE
Practice Address - Street 2:SUITE 42A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1937
Practice Address - Country:US
Practice Address - Phone:917-597-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420660363LW0102X
NY000392367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health