Provider Demographics
NPI:1073805701
Name:LEO F KATZ INC
Entity Type:Organization
Organization Name:LEO F KATZ INC
Other - Org Name:OTOHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:F
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:HIS ACA
Authorized Official - Phone:631-673-5820
Mailing Address - Street 1:771 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4221
Mailing Address - Country:US
Mailing Address - Phone:631-673-5820
Mailing Address - Fax:
Practice Address - Street 1:771 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4221
Practice Address - Country:US
Practice Address - Phone:631-673-5820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
NY15000001731237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1124039920Medicaid