Healthcare Provider Details

I. General information

NPI: 1407553381
Provider Name (Legal Business Name): CATHERINE GISSEL PAYANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1197
US

IV. Provider business mailing address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-3419
  • Fax:
Mailing address:
  • Phone: 718-589-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number064166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: