1689945057 NPI number — DR. EDITH N HOLLENBERG OD

Table of content: DR. EDITH N HOLLENBERG OD (NPI 1689945057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689945057 NPI number — DR. EDITH N HOLLENBERG OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLENBERG
Provider First Name:
EDITH
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLLENBERG
Provider Other First Name:
EDY
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689945057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18000 GROSCHKE RD.
Provider Second Line Business Mailing Address:
D-2
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-492-8018
Provider Business Mailing Address Fax Number:
281-492-9687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18000 GROSCHKE RD.
Provider Second Line Business Practice Location Address:
D-2
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-492-8018
Provider Business Practice Location Address Fax Number:
281-492-9687
Provider Enumeration Date:
01/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5678T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)