Healthcare Provider Details

I. General information

NPI: 1104910082
Provider Name (Legal Business Name): DANIEL M KATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EASTDALE AVE N
POUGHKEEPSIE NY
12603
US

IV. Provider business mailing address

243 NORTH RD STE 304
POUGHKEEPSIE NY
12601-1172
US

V. Phone/Fax

Practice location:
  • Phone: 845-437-5000
  • Fax:
Mailing address:
  • Phone: 845-451-7251
  • Fax: 845-451-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number191734
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number1917341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: