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General NPI Number Information
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NPI Number | 1679947519
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Entity Type | Individual
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Provider Name | KATHERINE CAZILAS PA
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Gender | Female
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 315 W 57TH ST
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City | NEW YORK
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State | NY
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Zip | 10019-3158
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Country | US
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Telephone | 212-315-2330
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 RXR PLZ FL 13
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City | UNIONDALE
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State | NY
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Zip | 11556-1301
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Country | US
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Telephone | 516-453-0435
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085005566
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 023521
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License Number State | NY
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