Provider Demographics
NPI:1225388226
Name:KATEV, DMITRIY (R,N,)
Entity Type:Individual
Prefix:MR
First Name:DMITRIY
Middle Name:
Last Name:KATEV
Suffix:
Gender:M
Credentials:R,N,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FATHER CAPODANNO
Mailing Address - Street 2:APT. 2M
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-727-0937
Mailing Address - Fax:
Practice Address - Street 1:18 FATHER CAPODANNO BLVD
Practice Address - Street 2:APT. 2M
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4843
Practice Address - Country:US
Practice Address - Phone:718-727-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY601137-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse