Healthcare Provider Details

I. General information

NPI: 1437859105
Provider Name (Legal Business Name): HOLTZMAN MEDICAL SPECIALTY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON ST STE 6B
BROOKLINE MA
02446-3806
US

IV. Provider business mailing address

1180 BEACON ST STE 6B
BROOKLINE MA
02446-3806
US

V. Phone/Fax

Practice location:
  • Phone: 781-770-4064
  • Fax: 949-867-4815
Mailing address:
  • Phone: 781-770-4064
  • Fax: 949-867-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN HOLTZMAN
Title or Position: OWNER
Credential: MD
Phone: 734-330-3336