Healthcare Provider Details

I. General information

NPI: 1457324915
Provider Name (Legal Business Name): KATHERINE ECONOMOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

PO BOX 5453
NEW YORK NY
10087-5453
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3272
  • Fax: 718-780-3079
Mailing address:
  • Phone: 718-780-3272
  • Fax: 718-780-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number174547
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: