Provider Demographics
NPI:1487660544
Name:KATZ, BERNARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3109
Mailing Address - Country:US
Mailing Address - Phone:516-433-7586
Mailing Address - Fax:516-433-7642
Practice Address - Street 1:8 LAURA LN
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3109
Practice Address - Country:US
Practice Address - Phone:516-433-7586
Practice Address - Fax:516-433-7642
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003549103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003549OtherSTATE LICENSE NUMBER
V18121Medicare ID - Type Unspecified