Healthcare Provider Details

I. General information

NPI: 1336195676
Provider Name (Legal Business Name): MARIANNE HOLLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MAIN ST STE D1
HOLMDEL NJ
07733-2136
US

IV. Provider business mailing address

23 MAIN ST STE D1
HOLMDEL NJ
07733-2136
US

V. Phone/Fax

Practice location:
  • Phone: 732-571-1000
  • Fax: 732-784-9704
Mailing address:
  • Phone: 732-571-1000
  • Fax: 732-784-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number25MB007885200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MB07885200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MB007885200
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number25MB07885200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: