Healthcare Provider Details

I. General information

NPI: 1639666043
Provider Name (Legal Business Name): KATHERINE NIEDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ESSEX ST STE 204
HACKENSACK NJ
07601-3245
US

IV. Provider business mailing address

211 ESSEX ST STE 204
HACKENSACK NJ
07601-3245
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-1240
  • Fax:
Mailing address:
  • Phone: 914-563-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA11811500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: