Provider Demographics
NPI:1235221870
Name:KATZ, MICHAEL (DPM)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
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 1:23 WEST MONTOUK HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-4003
Mailing Address - Country:US
Mailing Address - Phone:631-728-4040
Mailing Address - Fax:631-728-4042
Practice Address - Street 1:23 WEST MONTOUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-4003
Practice Address - Country:US
Practice Address - Phone:631-728-4040
Practice Address - Fax:631-728-4042
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0057981213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02150296Medicaid
NY02150296Medicaid
NY06266GMedicare PIN