Provider Demographics
NPI:1164485827
Name:KATZ, ALEX (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 AVENUE P, LOWER LEVEL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-615-4444
Mailing Address - Fax:718-615-4446
Practice Address - Street 1:1309 AVENUE P, LOWER LEVEL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-615-4444
Practice Address - Fax:718-615-4446
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005336213E00000X
NY005336213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01803965Medicaid
NYPQW131Medicare PIN
NYU67244Medicare UPIN
NY01803965Medicaid