=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902105786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. NINA KATZANDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2011
-----------------------------------------------------
Last Update Date | 08/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 CENTRAL PARK W SUITE 1K
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10024-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-644-9799
-----------------------------------------------------
Fax | 212-362-9525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 CENTRAL PARK W SUITE 1K
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10024-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-644-9799
-----------------------------------------------------
Fax | 212-362-9525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 019033
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 019033
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------