Healthcare Provider Details

I. General information

NPI: 1023722022
Provider Name (Legal Business Name): KATAN ORTHOPEDICS & SPINE SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 SHERIDAN ST STE 101
HOLLYWOOD FL
33021-3633
US

IV. Provider business mailing address

17801 N BAY RD APT 501
SUNNY ISLES BEACH FL
33160-1907
US

V. Phone/Fax

Practice location:
  • Phone: 646-346-4304
  • Fax:
Mailing address:
  • Phone: 646-346-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOB KATANOV
Title or Position: PRESIDENT
Credential: PA
Phone: 646-346-4304