Healthcare Provider Details

I. General information

NPI: 1053959544
Provider Name (Legal Business Name): AHUVA HOLLANDER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YURTZA AHUVA HOLLANDER

II. Dates (important events)

Enumeration Date: 12/15/2019
Last Update Date: 12/15/2019
Certification Date: 12/15/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MADISON AVE
LAKEWOOD NJ
08701-3225
US

IV. Provider business mailing address

37 PONDEROSA DR
LAKEWOOD NJ
08701-5156
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-7770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00994600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: