Provider Demographics
NPI:1477689362
Name:SUSAN KATZ MD
Entity Type:Organization
Organization Name:SUSAN KATZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-518-8888
Mailing Address - Street 1:1578 WILLIASBRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6265
Mailing Address - Country:US
Mailing Address - Phone:718-518-8888
Mailing Address - Fax:718-518-8616
Practice Address - Street 1:1578 WILLIASBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6265
Practice Address - Country:US
Practice Address - Phone:718-518-8888
Practice Address - Fax:718-518-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC12336Medicare UPIN
NYWCG261Medicare PIN