Provider Demographics
NPI:1104925288
Name:HOLLENBERG, N ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:N
Middle Name:ANN
Last Name:HOLLENBERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BRAUNCROFT LANE
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-9898
Mailing Address - Fax:
Practice Address - Street 1:3495 BAILEY AVENUE
Practice Address - Street 2:VETERANS ADMINISTRATION HOSPITAL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-862-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005649213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02184132Medicaid
NY02184132Medicaid
NYCC7901Medicare ID - Type UnspecifiedPROVIDER NUMBER