MEDICARE: IRINA KATS NP-C

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	363LG0600X	Gerontology Nurse Practitioner	F307452-1	NY

General Provider Information

NPI Number	:	1780034603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA KATS NP-C

Provider Business Mailing Address
First Line	:	156 JACKSON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4740
Country	:	US
Telephone Number	:	347-601-0492
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 JACKSON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4740
Country	:	US
Telephone Number	:	347-601-0492
Fax Number	:

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

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	06/22/2016

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