Healthcare Provider Details

I. General information

NPI: 1508940834
Provider Name (Legal Business Name): STEVEN KATZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 EAST CENTRAL AVE.
AVIS PA
17721-0430
US

IV. Provider business mailing address

PO BOX 430
AVIS PA
17721-0430
US

V. Phone/Fax

Practice location:
  • Phone: 570-753-8077
  • Fax: 570-753-5489
Mailing address:
  • Phone: 570-753-8077
  • Fax: 570-753-5489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS003250L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: