Provider Demographics
NPI:1790534584
Name:HOLBOK, MATTHEW ANDREW (FNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ANDREW
Last Name:HOLBOK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5146 HIGHBRIDGE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2408
Mailing Address - Country:US
Mailing Address - Phone:716-573-1527
Mailing Address - Fax:
Practice Address - Street 1:5146 HIGHBRIDGE ST APT 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2408
Practice Address - Country:US
Practice Address - Phone:716-573-1527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine