MEDICARE: IVANIA PERALTA KATTENGELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	31386501	NY
2	208000000X	Pediatrics Physician	M0862	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205916186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVANIA PERALTA KATTENGELL M.D.

Provider Business Mailing Address
First Line	:	400 FORT WASHINGTON AVE APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-6837
Country	:	US
Telephone Number	:	212-923-8500
Fax Number	:	212-923-6718

Provider Business Practice Location Address
First Line	:	400 FORT WASHINGTON AVE APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-6837
Country	:	US
Telephone Number	:	212-923-8500
Fax Number	:	212-923-6718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	11/16/2025

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