1750566691 NPI number — HOLLY A PRENTICE PT

Table of content: DR. LAWRENCE STEPHEN ROSENTHAL M.D. (NPI 1942359021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750566691 NPI number — HOLLY A PRENTICE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRENTICE
Provider First Name:
HOLLY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SLONIEWSKY
Provider Other First Name:
HOLLY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750566691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18220 STATE HIGHWAY 249 STE 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77070-4349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-807-4380
Provider Business Mailing Address Fax Number:
281-501-5999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18220 STATE HIGHWAY 249 STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77070-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-807-4380
Provider Business Practice Location Address Fax Number:
281-501-5999
Provider Enumeration Date:
01/09/2008

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: 225100000X , with the licence number:  17584 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 1185348 , 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)