Healthcare Provider Details

I. General information

NPI: 1760443618
Provider Name (Legal Business Name): MICHAEL S KATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EMPIRE DR SUITE 100
RENSSELAER NY
12144-5730
US

IV. Provider business mailing address

PO BOX 689
TROY NY
12181-0689
US

V. Phone/Fax

Practice location:
  • Phone: 518-286-4899
  • Fax: 518-286-4859
Mailing address:
  • Phone: 518-268-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number172650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: