Healthcare Provider Details

I. General information

NPI: 1720171853
Provider Name (Legal Business Name): DITZA KATZ PT, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SUNNYSIDE BLVD STE A
PLAINVIEW NY
11803-1517
US

IV. Provider business mailing address

54 SUNNYSIDE BLVD STE A
PLAINVIEW NY
11803-1517
US

V. Phone/Fax

Practice location:
  • Phone: 516-576-1118
  • Fax: 516-576-8876
Mailing address:
  • Phone: 516-576-1118
  • Fax: 516-576-8876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009171-1
License Number StateNY

VII. Legacy identifiers

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

# 1
IdentifierQ59841
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerPHYSICAL THERAPY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: