Healthcare Provider Details

I. General information

NPI: 1295667764
Provider Name (Legal Business Name): PETER J HOLZER CPSRP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CLINTON AVE
BRIDGEPORT CT
06605-1732
US

IV. Provider business mailing address

112 CLINTON AVE
BRIDGEPORT CT
06605-1732
US

V. Phone/Fax

Practice location:
  • Phone: 475-365-1874
  • Fax:
Mailing address:
  • Phone: 475-365-1874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPSRP-8687
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: