Healthcare Provider Details

I. General information

NPI: 1598025249
Provider Name (Legal Business Name): NICHOLAS SEAN KATCHEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST LUTHERAN MEDICAL CENTER - STATION 3-03
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

150 55TH ST. LUTHERAN MEDICAL CENTER STATION 3-03
BROOKLYN NY
11220
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-6808
  • Fax: 718-630-8894
Mailing address:
  • Phone: 718-630-6808
  • Fax: 718-630-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number057362
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number057362
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number057362
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number57362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: