Healthcare Provider Details

I. General information

NPI: 1134563349
Provider Name (Legal Business Name): RICHARD KATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SHELBURNE RD
STAMFORD CT
06902-3628
US

IV. Provider business mailing address

30 SHELBURNE RD
STAMFORD CT
06902-3628
US

V. Phone/Fax

Practice location:
  • Phone: 800-828-0898
  • Fax:
Mailing address:
  • Phone: 800-828-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number55315
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: