Healthcare Provider Details

I. General information

NPI: 1245320506
Provider Name (Legal Business Name): AMIRAM KATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 S LAMBERT RD
ORANGE CT
06477-3559
US

IV. Provider business mailing address

291 S LAMBERT RD
ORANGE CT
06477-3559
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-5425
  • Fax:
Mailing address:
  • Phone: 203-785-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number030483
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: