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General NPI Number Information
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NPI Number | 1235312034
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Entity Type | Organization
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Legal Business Name | FRED H. KATZ M.D.P.C.
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 21 CLARK PL
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City | MAHOPAC
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State | NY
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Zip | 10541-4723
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Country | US
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Telephone | 845-628-3033
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Fax | 845-628-8548
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Provider Business Mailing Address
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Address Line | PO BOX 611
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City | MAHOPAC
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State | NY
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Zip | 10541-0611
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Country | US
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Telephone | 845-628-3033
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Fax | 845-628-8548
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY BRIAN KATZ
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Credential | M.D.
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Telephone | 845-628-3033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 193160
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License Number State | NY
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