Provider Demographics
NPI:1205890977
Name:KATZ, LEON VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:VICTOR
Last Name:KATZ
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 1:430 SHORE ROAD SUITE B7D
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3221
Mailing Address - Country:US
Mailing Address - Phone:567-666-4666
Mailing Address - Fax:516-266-1165
Practice Address - Street 1:430 SHORE ROAD SUITE B7D
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561
Practice Address - Country:US
Practice Address - Phone:484-343-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224351208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02648066Medicaid
PA101619989Medicaid
PA101813OtherMEDICARE PTAN
NY1899H1OtherMEDICARE PTAN