Healthcare Provider Details

I. General information

NPI: 1174362032
Provider Name (Legal Business Name): FRED HOLTZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S OYSTER BAY RD
PLAINVIEW NY
11803-3310
US

IV. Provider business mailing address

535 S OYSTER BAY RD
PLAINVIEW NY
11803-3310
US

V. Phone/Fax

Practice location:
  • Phone: 516-888-4357
  • Fax: 516-513-1456
Mailing address:
  • Phone: 516-888-4357
  • Fax: 516-513-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TERRI SWINARSKI
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-888-4357