Healthcare Provider Details

I. General information

NPI: 1558629428
Provider Name (Legal Business Name): KATHERINE IRENE URANECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23303 BAY AVE FL. 1
LITTLE NECK NY
11363-1249
US

IV. Provider business mailing address

23303 BAY AVE FL. 1
LITTLE NECK NY
11363-1249
US

V. Phone/Fax

Practice location:
  • Phone: 212-831-1380
  • Fax:
Mailing address:
  • Phone: 212-831-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number173943
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: