Provider Demographics
NPI:1952499089
Name:KATZ, DAVID ABRAHAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ABRAHAM
Last Name:KATZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E 12TH ST APT 3J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1061
Mailing Address - Country:US
Mailing Address - Phone:718-998-0079
Mailing Address - Fax:
Practice Address - Street 1:9811 QUEENS BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3323
Practice Address - Country:US
Practice Address - Phone:718-830-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006180-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02886551Medicaid
NY02886551Medicaid
NY08117Medicare PIN
V12531Medicare UPIN