Provider Demographics
NPI:1184879785
Name:DR KENNETH KATZ
Entity type:Organization
Organization Name:DR KENNETH KATZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-889-2300
Mailing Address - Street 1:270 EDWARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3402
Mailing Address - Country:US
Mailing Address - Phone:516-889-2300
Mailing Address - Fax:516-889-2300
Practice Address - Street 1:270 EDWARDS BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3402
Practice Address - Country:US
Practice Address - Phone:516-889-2300
Practice Address - Fax:516-889-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00790170Medicaid
NY00790170Medicaid