Healthcare Provider Details

I. General information

NPI: 1952833576
Provider Name (Legal Business Name): ASSAF HOLTZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COMMUNITY DR
MANHASSET NY
11030-3815
US

IV. Provider business mailing address

400 COMMUNITY DR
MANHASSET NY
11030-3815
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4280
  • Fax:
Mailing address:
  • Phone: 516-562-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number318138
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: