Healthcare Provider Details

I. General information

NPI: 1790732451
Provider Name (Legal Business Name): ROY A HOLLIDAY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EAST 14TH STREET
NEW YORK NY
10003-4201
US

IV. Provider business mailing address

1 GUSTAVE L. LEVY PLACE BOX 1194
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-979-4400
  • Fax: 212-590-2982
Mailing address:
  • Phone: 212-241-8395
  • Fax: 212-289-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number156798
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: