Healthcare Provider Details

I. General information

NPI: 1619984424
Provider Name (Legal Business Name): JASON E HOLDEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E 52ND ST SUITE 1200
NEW YORK NY
10022-5306
US

IV. Provider business mailing address

16 E 52ND ST SUITE 1200
NEW YORK NY
10022-5306
US

V. Phone/Fax

Practice location:
  • Phone: 212-486-6622
  • Fax: 212-486-0449
Mailing address:
  • Phone: 212-486-6622
  • Fax: 212-486-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number051123
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: