Provider Demographics
NPI:1629436332
Name:KATZ, JUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 CENTER BLVD APT 3102
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5771
Mailing Address - Country:US
Mailing Address - Phone:845-807-6409
Mailing Address - Fax:
Practice Address - Street 1:130 W 42ND ST
Practice Address - Street 2:SUITE 1055
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7902
Practice Address - Country:US
Practice Address - Phone:866-938-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor