Glen A Holley, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00148700 Issued in NJ

Practice address

171 Lake St
Ramsey, NJ 07446-2089

Phone

(201) 785-0011

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Adam Alex, LLC

  • Family Medicine Physician
  • Edgewater, NJ
  • NPI 1215346218
  Medicare reassignment
• Dispatch Health Medical PC

  • Emergency Medicine Physician
  • Upper Saddle River, NJ
  • NPI 1447716873
  Medicare reassignment
• Prompt MD LLC

  • Family Medicine Physician
  • Hoboken, NJ
  • NPI 1205073079
  Medicare reassignment
• Marshall Amaya & Anton P L

  • Emergency Medicine Physician
  • Miami, FL
  • NPI 1669419529

  Physician Assistant

  NPD (past)
• Pharma Holding Inc

  • Pharmacy
  • Brooklyn, NY
  • NPI 1396153680
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1891889705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 LAKE ST",
            "city": "RAMSEY",
            "state": "NJ",
            "postal_code": "074462089",
            "telephone_number": "201-785-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 LAKE ST",
            "city": "RAMSEY",
            "state": "NJ",
            "postal_code": "074462089",
            "telephone_number": "201-785-0011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 Tice Blvd Ste A35",
            "address_purpose": "LOCATION",
            "city": "Woodcliff Lake",
            "state": "NJ",
            "postal_code": "076777681",
            "country_code": "US",
            "telephone_number": "201-882-7526",
            "fax_number": "855-213-1277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLEY",
        "first_name": "GLEN",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00148700",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Henzel, M.ED.
• Heritage Vascular PC
• Lorraine Hernandez, OTR/L
• Thomas J Higgins, HA DISPENSER
• Laura Holland, LPC
• Home Harmony ABA NJ LLC
• Marissa Horwitz, MA, BCBA LBA
• Lauren E Hudon, BCBA
• Hudson Hill Group
• Meredith Walsh Hudson, M.A. CCC-SLP

• Physician Assistant in Ramsey, NJ
• Providers in Ramsey, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.