Provider Demographics
NPI:1891776084
Name:KATIME, EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:KATIME
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 1:877 STEWART AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4803
Mailing Address - Country:US
Mailing Address - Phone:516-222-1616
Mailing Address - Fax:516-222-0437
Practice Address - Street 1:877 STEWART AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4803
Practice Address - Country:US
Practice Address - Phone:516-222-1616
Practice Address - Fax:516-222-0437
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143976174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04001367OtherRAILROAD MEDICARE
NY131154OtherGREAT WEST ONE HEALTH PLA
NY65A311OtherBLUE CROSS BLUE SHIELD
NYOC6302OtherHEALTH NET INSURANCE
NY00946263Medicaid
NY10-00001OtherUNITED HEALTHCARE
NYAL46518OtherMDNY
NYAS1107OtherOXFORD
NY449OtherVYTRA HEALTH PLANS
NY53593OtherGHI HMO
NY0061915OtherGHI INSURANCE
NY0061915OtherGHI INSURANCE
NYOC6302OtherHEALTH NET INSURANCE