Provider Demographics
NPI:1508931494
Name:KATZ, MARTIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5204
Mailing Address - Country:US
Mailing Address - Phone:718-745-5499
Mailing Address - Fax:718-921-4661
Practice Address - Street 1:6216 11TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5204
Practice Address - Country:US
Practice Address - Phone:718-745-5499
Practice Address - Fax:718-921-4661
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist