Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 040711 | NY |
NPI | 1043396930 |
---|---|
Provider Name | Dr. Lawrence Steven Holtzman |
First Address | Bronx, NY 10461-2732 |
Second Address | Bronx, NY 10461-2732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 24/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U28773 | (02) | NY |