MEDICARE: DR. S JEROME HOLTZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MA 28482	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215993712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. S JEROME HOLTZ M.D.

Provider Business Mailing Address
First Line	:	108 BROUGHTON AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-3989
Country	:	US
Telephone Number	:	973-743-1331
Fax Number	:	973-743-6577

Provider Business Practice Location Address
First Line	:	108 BROUGHTON AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-3989
Country	:	US
Telephone Number	:	973-743-1331
Fax Number	:	973-743-6577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	07/31/2007

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