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General NPI Number Information
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NPI Number | 1861707952
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Entity Type | Organization
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Legal Business Name | INGOLF HOLM-ANDERSON
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 10 MEDICAL PLAZA
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City | GLEN COVE
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State | NY
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Zip | 11542
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Country | US
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Telephone | 516-759-0448
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Fax | 516-759-0449
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Provider Business Mailing Address
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Address Line | 10 MEDICAL PLAZA
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City | GLEN COVE
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State | NY
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Zip | 11542
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Country | US
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Telephone | 516-759-0448
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Fax | 516-759-0453
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Authorized Official
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Title or Position | OWNER
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Name | INGOLF HOLM-ANDERSEN
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Credential | MD
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Telephone | 516-759-0448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 108069
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License Number State | NY
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