Healthcare Provider Details

I. General information

NPI: 1124105465
Provider Name (Legal Business Name): LENORE SELF KATKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 CENTRAL PARK AVE
YONKERS NY
10704-1059
US

IV. Provider business mailing address

2700 WESTCHESTER AVE 2ND FLOOR
PURCHASE NY
10577-2547
US

V. Phone/Fax

Practice location:
  • Phone: 914-423-7700
  • Fax: 914-424-2805
Mailing address:
  • Phone: 914-682-6538
  • Fax: 914-457-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number083456
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: