Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 235952 | NY |
Y | 2080A0000X | Adolescent Medicine | 235952 | NY |
N | 2080A0000X | Adolescent Medicine | C145084 | CA |
NPI | 1205030228 |
---|---|
Provider Name | Dr. Dominic Hollman |
First Address | New Rochelle, NY 10801-4825 |
Second Address | Bronx, NY 10467-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 22/05/2019 |