Provider Demographics
NPI:1083600662
Name:KATZ, AVERY SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:AVERY
Middle Name:SETH
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:4 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1664
Practice Address - Country:US
Practice Address - Phone:973-471-3680
Practice Address - Fax:973-471-6360
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA065473002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7235801Medicaid
130016670OtherRAILROAD MEDICARE
P605465OtherOXFORD
NJ84414OtherAMERIGROUP
NJPS000004300OtherAMERICHOICE
NJ1758979OtherUNITED HEALTHCARE
45158495OtherAETNA
OK5826OtherHEALTHNET
NJ84414OtherAMERIGROUP
906429BF5Medicare PIN