Provider Demographics
NPI:1780651745
Name:KATZ, JEFFREY HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HOWARD
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5160
Mailing Address - Country:US
Mailing Address - Phone:860-646-1000
Mailing Address - Fax:860-645-1120
Practice Address - Street 1:595 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5160
Practice Address - Country:US
Practice Address - Phone:860-646-1000
Practice Address - Fax:860-645-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110003969Medicare ID - Type Unspecified
CTD80814Medicare UPIN