Healthcare Provider Details

I. General information

NPI: 1861746174
Provider Name (Legal Business Name): KATHERINE AUSTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 5TH AVE 22B
NEW YORK NY
10035-2772
US

IV. Provider business mailing address

1485 5TH AVE 22B
NEW YORK NY
10035-2772
US

V. Phone/Fax

Practice location:
  • Phone: 917-261-7785
  • Fax:
Mailing address:
  • Phone: 917-261-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number263767
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number263767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: