Healthcare Provider Details

I. General information

NPI: 1467719500
Provider Name (Legal Business Name): CHRISTOPHER HOLLWEG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD
NEW HYDE PARK NY
11042-1101
US

IV. Provider business mailing address

355 BARD AVE
STATEN ISLAND NY
10310-1664
US

V. Phone/Fax

Practice location:
  • Phone: 516-321-8063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number286166
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number286166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: