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General NPI Number Information
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NPI Number | 1154324457
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Entity Type | Individual
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Provider Name | KATHERINE MASTROTA OD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2785 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11235-7838
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Country | US
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Telephone | 718-646-2200
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Fax | 718-646-6623
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Provider Business Mailing Address
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Address Line | 2785 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11235-7838
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Country | US
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Telephone | 718-646-2200
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Fax | 718-646-6623
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0050013
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License Number State | NY
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