Healthcare Provider Details

I. General information

NPI: 1679620769
Provider Name (Legal Business Name): BRUCE E. KATZ, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E 56TH ST 2ND FLOOR
NEW YORK NY
10022-3204
US

IV. Provider business mailing address

60 E 56TH ST 2ND FLOOR
NEW YORK NY
10022-3204
US

V. Phone/Fax

Practice location:
  • Phone: 212-688-5882
  • Fax: 212-421-9502
Mailing address:
  • Phone: 212-688-5882
  • Fax: 212-421-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number134724-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number134724-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number134724-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number134724-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number141259-1
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number134724-1
License Number StateNY

VIII. Authorized Official

Name: DR. BRUCE KATZ
Title or Position: DIRECTOR
Credential: M.D.
Phone: 212-688-5882