Provider Demographics
NPI:1760072870
Name:KRATZ, MADELINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:KRATZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:KRATZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:280 PARK AVE S APT 24E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6134
Mailing Address - Country:US
Mailing Address - Phone:203-644-8366
Mailing Address - Fax:
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:718-499-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
NY026421363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty