Healthcare Provider Details

I. General information

NPI: 1295448108
Provider Name (Legal Business Name): MS. ELIZABETH HOLLENBECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 HARMATI LN
BEARSVILLE NY
12409-5130
US

IV. Provider business mailing address

122 HARMATI LN
BEARSVILLE NY
12409-5130
US

V. Phone/Fax

Practice location:
  • Phone: 845-853-6841
  • Fax:
Mailing address:
  • Phone: 845-853-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: