Healthcare Provider Details

I. General information

NPI: 1053572404
Provider Name (Legal Business Name): STUART MARC HOLZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TECHNOLOGY DR SUITE 250
EAST SETAUKET NY
11733-4080
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4601
  • Fax: 631-444-4990
Mailing address:
  • Phone: 631-444-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number255900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: