Provider Demographics
NPI:1003028101
Name:KATZ, KENNETH B (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:KATZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 EDWARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3402
Mailing Address - Country:US
Mailing Address - Phone:516-889-2300
Mailing Address - Fax:
Practice Address - Street 1:270 EDWARDS BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3402
Practice Address - Country:US
Practice Address - Phone:516-889-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3569-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5641070001Medicare NSC
NYT51144Medicare UPIN
NYP3569-1Medicare PIN