Provider Demographics
NPI:1831499375
Name:SAM KATZURIN MD PC
Entity Type:Organization
Organization Name:SAM KATZURIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZURIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-482-2034
Mailing Address - Street 1:11 STONY RUN RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1923
Mailing Address - Country:US
Mailing Address - Phone:516-482-2034
Mailing Address - Fax:516-829-2539
Practice Address - Street 1:161 ATLANTIC AVE
Practice Address - Street 2:STE. 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6720
Practice Address - Country:US
Practice Address - Phone:718-852-5232
Practice Address - Fax:718-596-9085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131528207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00374552Medicaid
NY00374552Medicaid