Provider Demographics
NPI:1922087808
Name:KATZ, MICAH SOLOMON (PA-C)
Entity Type:Individual
Prefix:PROF
First Name:MICAH
Middle Name:SOLOMON
Last Name:KATZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 STATE ROUTE 208
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1611
Mailing Address - Country:US
Mailing Address - Phone:845-836-1111
Mailing Address - Fax:845-400-2428
Practice Address - Street 1:501 STATE ROUTE 208
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1611
Practice Address - Country:US
Practice Address - Phone:845-836-1111
Practice Address - Fax:845-400-2428
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007897207R00000X, 208100000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P24022Medicare UPIN