Provider Demographics
NPI:1326052333
Name:ZILLMANN, CATHERINE (NPP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:ZILLMANN
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 ROUTE 111 STE 103
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4750
Mailing Address - Country:US
Mailing Address - Phone:631-864-9202
Mailing Address - Fax:631-265-3205
Practice Address - Street 1:363 ROUTE 111 STE 103
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4750
Practice Address - Country:US
Practice Address - Phone:631-864-9202
Practice Address - Fax:631-265-3205
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400964-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health