Provider Demographics
NPI:1710127675
Name:BRUCE E. KATZ, MD, PC
Entity Type:Organization
Organization Name:BRUCE E. KATZ, MD, PC
Other - Org Name:JUVA SKIN & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-688-5882
Mailing Address - Street 1:27 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3901
Mailing Address - Country:US
Mailing Address - Phone:718-636-0425
Mailing Address - Fax:718-636-1308
Practice Address - Street 1:27 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3901
Practice Address - Country:US
Practice Address - Phone:718-636-0425
Practice Address - Fax:718-636-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56A981Medicare UPIN