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General NPI Number Information
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NPI Number | 1770945081
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Entity Type | Individual
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Provider Name | AMY L HOLMSTROM MD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 1300 YORK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-4805
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Country | US
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Telephone | 646-962-8462
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 YORK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-4805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 1770945081
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01090322A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 315996
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License Number State | NY
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