Provider Demographics
NPI:1033129978
Name:KATECHIS, DENNIS (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:KATECHIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 N DEAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2533
Mailing Address - Country:US
Mailing Address - Phone:201-816-2508
Mailing Address - Fax:201-569-6111
Practice Address - Street 1:177 N DEAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2533
Practice Address - Country:US
Practice Address - Phone:201-816-2508
Practice Address - Fax:201-569-6111
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211605207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02548745Medicaid
NY02548745Medicaid
I04737Medicare UPIN
NY554Q41Medicare ID - Type Unspecified