Provider Demographics
NPI:1093277881
Name:KATZ, ADAM JORDAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JORDAN
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 1:55 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4427
Mailing Address - Country:US
Mailing Address - Phone:203-834-2436
Mailing Address - Fax:203-762-1999
Practice Address - Street 1:55 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4427
Practice Address - Country:US
Practice Address - Phone:203-834-2436
Practice Address - Fax:203-762-1999
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS91631208000000X
MST-3788208000000X
390200000X
CT733132080A0000X
FL154381208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program