Provider Demographics
NPI:1669510921
Name:MICHAEL KATZ, D.P.M., P.C.
Entity Type:Organization
Organization Name:MICHAEL KATZ, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-723-5616
Mailing Address - Street 1:13704 GUY R BREWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3700
Mailing Address - Country:US
Mailing Address - Phone:718-723-5616
Mailing Address - Fax:718-723-5627
Practice Address - Street 1:13704 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3700
Practice Address - Country:US
Practice Address - Phone:718-723-5616
Practice Address - Fax:718-723-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005798213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02150296Medicaid
NY06266Medicare PIN
NY4512360001Medicare NSC
NYU85162Medicare UPIN