Provider Demographics
NPI:1114960259
Name:KATZ, JODIE HANNAH
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:HANNAH
Last Name:KATZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FRANKLINE TPKE
Mailing Address - Street 2:VALLEY HEALTH MEDICAL GROUP
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463
Mailing Address - Country:US
Mailing Address - Phone:201-447-3603
Mailing Address - Fax:201-447-5184
Practice Address - Street 1:140 FRANKLINE TPKE
Practice Address - Street 2:VALLEY HEALTH MEDICAL GROUP
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463
Practice Address - Country:US
Practice Address - Phone:201-447-3603
Practice Address - Fax:201-447-5184
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5284200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ572389WC0Medicare PIN
NJ572389Medicare ID - Type Unspecified