Provider Demographics
NPI:1639988660
Name:HOLLOWAY, JEDAIAH S
Entity type:Individual
Prefix:MS
First Name:JEDAIAH
Middle Name:S
Last Name:HOLLOWAY
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 1:4 BRETT CT
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07438-9358
Mailing Address - Country:US
Mailing Address - Phone:973-296-6999
Mailing Address - Fax:
Practice Address - Street 1:4 BRETT CT
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9358
Practice Address - Country:US
Practice Address - Phone:973-296-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy