Healthcare Provider Details

I. General information

NPI: 1699887323
Provider Name (Legal Business Name): TATYANA I KATZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date: 08/21/2026
Reactivation Date: 08/31/2026

III. Provider practice location address

1403 AVENUE J
BROOKLYN NY
11230-3701
US

IV. Provider business mailing address

1403 AVENUE J
BROOKLYN NY
11230-3701
US

V. Phone/Fax

Practice location:
  • Phone: 718-534-4651
  • Fax: 718-534-4654
Mailing address:
  • Phone: 718-534-4651
  • Fax: 718-534-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberRT007684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: