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NPI Code Detail

MEDICARE: KATLYN M LAVIN PA-C

MEDICARE: KATLYN M LAVIN PA-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
1363A00000XPhysician Assistant024167NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA4809OTHERMALICENSE

General Provider Information

NPI Number : 1881027589
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATLYN M LAVIN PA-C
Provider Business Mailing Address
First Line : 1345 RXR PLZ FL 13
Second Line :
City : UNIONDALE
State : NY
Zip : 11556-1301
Country : US
Telephone Number : 516-453-0435
Fax Number :
Provider Business Practice Location Address
First Line : 2280 N OCEAN AVE
Second Line :
City : FARMINGVILLE
State : NY
Zip : 11738-2911
Country : US
Telephone Number : 631-698-7828
Fax Number : 631-698-3300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2013
Last Update Date : 01/07/2020

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