Healthcare Provider Details

I. General information

NPI: 1609943885
Provider Name (Legal Business Name): DAVID VINING HOLBROOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 STARE HWY NO 31 APT A
LEBANON NJ
08833
US

IV. Provider business mailing address

53 MAIN ST
BLOOMSBURY NJ
08804-3073
US

V. Phone/Fax

Practice location:
  • Phone: 908-730-5900
  • Fax: 908-730-5900
Mailing address:
  • Phone: 908-479-4229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA68209
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMA68209
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: