Provider Demographics
NPI:1962035923
Name:DELONG, HOLLY LYNN (MD, RDN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:DELONG
Suffix:
Gender:F
Credentials:MD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117A E MORNING GLORY RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD CREST
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-4313
Mailing Address - Country:US
Mailing Address - Phone:215-570-3919
Mailing Address - Fax:
Practice Address - Street 1:2000 SHORE RD STE 104
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2100
Practice Address - Country:US
Practice Address - Phone:609-904-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered