Provider Demographics
NPI:1679768097
Name:KATZ, LILLIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 FORSGATE DR
Mailing Address - Street 2:
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1567
Mailing Address - Country:US
Mailing Address - Phone:732-521-3131
Mailing Address - Fax:732-521-1116
Practice Address - Street 1:333 FORSGATE DR
Practice Address - Street 2:
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1567
Practice Address - Country:US
Practice Address - Phone:732-521-3131
Practice Address - Fax:732-521-1116
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00124300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223586872OtherTAX ID#
NJQ31219Medicare UPIN
NJ086393MFWMedicare PIN