Healthcare Provider Details

I. General information

NPI: 1376015909
Provider Name (Legal Business Name): SAMUEL HOELZLE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 BROADWAY
NEW YORK NY
10003-9616
US

IV. Provider business mailing address

726 BROADWAY FL 3
NEW YORK NY
10003-9580
US

V. Phone/Fax

Practice location:
  • Phone: 212-443-1000
  • Fax:
Mailing address:
  • Phone: 212-443-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number706633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: