Healthcare Provider Details

I. General information

NPI: 1104925288
Provider Name (Legal Business Name): N ANN HOLLENBERG D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BAILEY AVENUE VETERANS ADMINISTRATION HOSPITAL
BUFFALO NY
14215
US

IV. Provider business mailing address

112 BRAUNCROFT LANE
SNYDER NY
14226
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-8934
  • Fax:
Mailing address:
  • Phone: 716-839-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005649
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: