Healthcare Provider Details

I. General information

NPI: 1679642607
Provider Name (Legal Business Name): STEPHEN B KATZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 ROUTE 17M
HARRIMAN NY
10926-3316
US

IV. Provider business mailing address

96 ROUTE 17M
HARRIMAN NY
10926-3316
US

V. Phone/Fax

Practice location:
  • Phone: 845-783-6466
  • Fax: 845-783-6468
Mailing address:
  • Phone: 845-783-6466
  • Fax: 845-783-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number026996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: