Healthcare Provider Details

I. General information

NPI: 1710223151
Provider Name (Legal Business Name): KATHERINA KASAP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COLUMBUS CIR 7TH FLOOR
NEW YORK NY
10019-1412
US

IV. Provider business mailing address

5 COLUMBUS CIR 7TH FLOOR
NEW YORK NY
10019-1412
US

V. Phone/Fax

Practice location:
  • Phone: 212-664-9323
  • Fax: 212-664-9341
Mailing address:
  • Phone: 212-664-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number016150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: