Provider Demographics
NPI:1669870507
Name:HOLLY C FOOTE, DO, LLC
Entity type:Organization
Organization Name:HOLLY C FOOTE, DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MS
Authorized Official - Phone:405-795-8291
Mailing Address - Street 1:326 EDGEWATER TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 EDGEWATER TOWNE CTR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-2222
Practice Address - Country:US
Practice Address - Phone:405-795-8291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272882-1208600000X
NJ25MB09608600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty