Provider Demographics
NPI:1568529857
Name:KATS, RADISLAV (LAC, MTOM)
Entity Type:Individual
Prefix:
First Name:RADISLAV
Middle Name:
Last Name:KATS
Suffix:
Gender:M
Credentials:LAC, MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W END AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4843
Mailing Address - Country:US
Mailing Address - Phone:718-934-2211
Mailing Address - Fax:718-934-2225
Practice Address - Street 1:2 W END AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4843
Practice Address - Country:US
Practice Address - Phone:718-934-2211
Practice Address - Fax:718-934-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001840-1174400000X
NY001840171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty