Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 170523 | NY |
NPI | 1003961889 |
---|---|
Provider Name | Robert Katz |
First Address | New Hyde Park, NY 11042-1101 |
Second Address | New Hyde Park, NY 11042-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 19/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01618611 | (05) | NY |
F27741 | (02) | NY |