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General NPI Number Information
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NPI Number | 1396762191
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Entity Type | Individual
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Provider Name | JACOB KATANOV P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 540 ATLANTIC AVE
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City | BROOKLYN
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State | NY
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Zip | 11217-1985
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Country | US
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Telephone | 718-855-4900
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Fax | 718-802-0631
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Provider Business Mailing Address
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Address Line | 2202 STEINWAY ST
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City | ASTORIA
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State | NY
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Zip | 11105-1836
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Country | US
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Telephone | 718-423-0808
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Fax | 718-204-6866
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 007935
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License Number State | NY
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