=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881744779
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA KATSEV OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 04/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2103 RALPH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-241-0400
-----------------------------------------------------
Fax | 718-968-6854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2103 RALPH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-241-0400
-----------------------------------------------------
Fax | 718-968-6854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | TUV06380
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------