Provider Demographics
NPI:1275695173
Name:FREDERICK-GALARZA, KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FREDERICK-GALARZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:531 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1000
Mailing Address - Country:US
Mailing Address - Phone:914-472-3333
Mailing Address - Fax:914-472-7247
Practice Address - Street 1:531 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1000
Practice Address - Country:US
Practice Address - Phone:914-472-3333
Practice Address - Fax:914-472-7247
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY207768OtherLICENSE NUMBER