Provider Demographics
NPI:1295274314
Name:LINDENWOOD HEALTH MEDICAL PC
Entity type:Organization
Organization Name:LINDENWOOD HEALTH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:862-208-9959
Mailing Address - Street 1:3974 AMBOY RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308
Mailing Address - Country:US
Mailing Address - Phone:718-967-1071
Mailing Address - Fax:718-966-0359
Practice Address - Street 1:3974 AMBOY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308
Practice Address - Country:US
Practice Address - Phone:718-967-1071
Practice Address - Fax:718-966-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05146507Medicaid