Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F000103 | NY |
NPI | 1073541306 |
---|---|
Provider Name | Theresa D Katulis |
First Address | Garden City, NY 11530-2133 |
Second Address | Jamaica, NY 11432-4727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 05/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02153395 | (05) | NY |
Q34857 | (02) | NY |