Provider Demographics
NPI:1265643068
Name:ORELLANA, KATHERINE ATIENZA (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ATIENZA
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:V
Other - Last Name:ATIENZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:509 KENDRICK ST
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1622
Mailing Address - Country:US
Mailing Address - Phone:201-401-2778
Mailing Address - Fax:
Practice Address - Street 1:155 POLIFLY RD STE 102
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1771
Practice Address - Country:US
Practice Address - Phone:551-996-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-06-27
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-24
Provider Licenses
StateLicense IDTaxonomies
NY2455992080P0206X
NJ25MB082638002080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology