Healthcare Provider Details

I. General information

NPI: 1356571384
Provider Name (Legal Business Name): HOLLY JOY SNYDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 WEST 168TH STREET COLUMBIA UNIVERSITY, PH 4-476
NYC NY
10032
US

IV. Provider business mailing address

40 W 116TH ST APT B301
NEW YORK NY
10026-2864
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5020
  • Fax:
Mailing address:
  • Phone: 917-579-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335827-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: