Provider Demographics
NPI:1053348417
Name:HOLCA, LIVIU T (MD)
Entity type:Individual
Prefix:MR
First Name:LIVIU
Middle Name:T
Last Name:HOLCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2419
Mailing Address - Country:US
Mailing Address - Phone:609-978-5524
Mailing Address - Fax:
Practice Address - Street 1:1137 BEACON AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2419
Practice Address - Country:US
Practice Address - Phone:609-978-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA54475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7194803Medicaid
NJ7194803Medicaid
NJ783394Medicare ID - Type Unspecified