Healthcare Provider Details

I. General information

NPI: 1730359894
Provider Name (Legal Business Name): ADAM M. KATOF, D.O., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL ROAD SUITE 312
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

100 MANETTO HILL ROAD SUITE 312
PLAINVIEW NY
11803-1311
US

V. Phone/Fax

Practice location:
  • Phone: 516-513-1720
  • Fax: 516-513-1722
Mailing address:
  • Phone: 516-513-1720
  • Fax: 516-513-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number218967
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02458868
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. ADAM M. KATOF
Title or Position: OWNER
Credential: D.O.
Phone: 516-513-1720