Healthcare Provider Details

I. General information

NPI: 1104798925
Provider Name (Legal Business Name): PETER KATZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2369 2ND AVE
NEW YORK NY
10035-3108
US

IV. Provider business mailing address

265 W 131ST ST APT 5
NEW YORK NY
10027-2179
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128148-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: