Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N3569-1 | NY |
Y | 222Z00000X | Podiatrist | N3569-1 | NY |
NPI | 1003028101 |
---|---|
Provider Name | Dr. Kenneth B Katz |
First Address | Long Beach, NY 11561-3402 |
Second Address | Long Beach, NY 11561-3402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 29/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T51144 | (02) | NY |