Provider Demographics
NPI:1407918675
Name:COSTAS-KATZ, CARMEN SILVIA (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:SILVIA
Last Name:COSTAS-KATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BEACH 95 ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693
Mailing Address - Country:US
Mailing Address - Phone:718-634-9384
Mailing Address - Fax:718-318-8866
Practice Address - Street 1:625 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5049
Practice Address - Country:US
Practice Address - Phone:718-933-1900
Practice Address - Fax:718-563-4039
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY203363OtherLICENCE NUMBER
NY01843672Medicaid
NY08033JMedicare PIN