Provider Demographics
NPI:1902492226
Name:HOLZER, DANIELLA (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:HOLZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15910 71ST AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3028
Mailing Address - Country:US
Mailing Address - Phone:201-906-4434
Mailing Address - Fax:
Practice Address - Street 1:496 SMITHTOWN BYP STE 200
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5011
Practice Address - Country:US
Practice Address - Phone:631-361-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY026324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant