Provider Demographics
NPI:1104893932
Name:MICHAEL S BUCHHOLTZ MD PC
Entity type:Organization
Organization Name:MICHAEL S BUCHHOLTZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUCHHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-427-6060
Mailing Address - Street 1:270 PULASKI ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:270 PULASKI ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740
Practice Address - Country:US
Practice Address - Phone:631-427-6060
Practice Address - Fax:631-549-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02221227Medicaid
4345870001Medicare NSC
NY02221227Medicaid