Provider Demographics
NPI:1154050631
Name:POLITI, KATELYN
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:
Last Name:POLITI
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 1:466 CHARLES LN
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1408
Mailing Address - Country:US
Mailing Address - Phone:516-965-5864
Mailing Address - Fax:
Practice Address - Street 1:466 CHARLES LN
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1408
Practice Address - Country:US
Practice Address - Phone:516-965-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist