Provider Demographics
NPI:1366486029
Name:KATZ, ALAN J (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:145 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3830
Mailing Address - Country:US
Mailing Address - Phone:516-426-1386
Mailing Address - Fax:732-387-2629
Practice Address - Street 1:21 W BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2170
Practice Address - Country:US
Practice Address - Phone:516-426-1386
Practice Address - Fax:732-387-2629
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1347232085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01242135Medicaid
NY77F271Medicare PIN
NYAK077F2710Medicare PIN
NY01242135Medicaid
NYP00193729Medicare PIN