Healthcare Provider Details

I. General information

NPI: 1972815231
Provider Name (Legal Business Name): MICHELLE WEISS KATZOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD STE 108
NEW HYDE PARK NY
11042-1102
US

IV. Provider business mailing address

34TH ST. & CIVIC CENTER BLVD THE CHILDREN'S HOSPITAL OF PHILADELPHIA, ROOM 9NW55
PHILADELPHIA PA
19104-4399
US

V. Phone/Fax

Practice location:
  • Phone: 516-465-5215
  • Fax: 516-465-5399
Mailing address:
  • Phone: 215-590-2437
  • Fax: 215-590-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number270333
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT197040
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: