Healthcare Provider Details

I. General information

NPI: 1205030228
Provider Name (Legal Business Name): DOMINIC HOLLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

53 EIGHTH ST
NEW ROCHELLE NY
10801-4825
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-6781
  • Fax: 718-920-5289
Mailing address:
  • Phone: 914-636-1206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number235952
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberC145084
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number235952
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: