Provider Demographics
NPI:1144034828
Name:FORDE, HOLLIS III
Entity type:Individual
Prefix:
First Name:HOLLIS
Middle Name:
Last Name:FORDE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 LEONHARDT CT
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5025
Mailing Address - Country:US
Mailing Address - Phone:551-293-9199
Mailing Address - Fax:
Practice Address - Street 1:44 LEONHARDT CT
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5025
Practice Address - Country:US
Practice Address - Phone:551-293-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJF65733356101062172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver