MS. MARYBETH HOLAK ARNP NPI 1518067230

NPI Information

NPI: 1518067230
Provider Name: MS. MARYBETH HOLAK, ARNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
428 COLUMBUS AVENUE
DERMATOLOGY
NEW HAVEN, CT
ZIP 06519
Phone: (203) 503-3000
Get Directions

MS. Marybeth Holak, ARNP is a family nurse practitioner in New Haven, CT with 29 years of experience. MS. Marybeth Holak, ARNP NPI is 1518067230. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

428 COLUMBUS AVENUE
DERMATOLOGY
NEW HAVEN, CT
ZIP 06519-233
Phone: (203) 503-3000
Fax: (203) 503-3224

The NPI 1518067230 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/23/2006 and was last updated on 10/30/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	6944	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	008075168	MEDICAID	CONNECTICUT
2	P61979	OTHER	NEW HAMPSHIRE	ANTHEM BCBS
3	P00067536	OTHER	NEW HAMPSHIRE	RAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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