Healthcare Provider Details

I. General information

NPI: 1952495798
Provider Name (Legal Business Name): ADAM S HOLZBERG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/26/2022
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 COLLEGE DR STE 2A
VINELAND NJ
08360-6933
US

IV. Provider business mailing address

1120 DELSEA DR N
GLASSBORO NJ
08028-1444
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-8680
  • Fax: 856-641-8679
Mailing address:
  • Phone: 856-507-2783
  • Fax: 856-566-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB06514100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberNJMB65141
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MB06514100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25MB06514100
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMB65141
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: