Provider Demographics
NPI:1457523540
Name:KATZ, NODAR (MD)
Entity type:Individual
Prefix:
First Name:NODAR
Middle Name:
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 1:13844 QUEENS BLVD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2653
Mailing Address - Country:US
Mailing Address - Phone:718-523-9811
Mailing Address - Fax:
Practice Address - Street 1:13844 QUEENS BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2653
Practice Address - Country:US
Practice Address - Phone:718-523-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
02552GOtherMEDICARE ID
NY01755311Medicaid
NYG52052Medicare UPIN