Provider Demographics
NPI:1508940834
Name:KATZ, STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:AVIS
Mailing Address - State:PA
Mailing Address - Zip Code:17721-0430
Mailing Address - Country:US
Mailing Address - Phone:570-753-8077
Mailing Address - Fax:570-753-5489
Practice Address - Street 1:104 EAST CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:AVIS
Practice Address - State:PA
Practice Address - Zip Code:17721-0430
Practice Address - Country:US
Practice Address - Phone:570-753-8077
Practice Address - Fax:570-753-5489
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003250L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158643OtherBLUE SHIELD
PA0006795690002Medicaid
PA4256987OtherAETNA
PA76590-6514OtherGEISINGER HEALTH PLAN
PA20053759OtherRAILROAD MEDICARE
PA815984OtherFIRST PRIORITY HEALTH
PA20053759OtherRAILROAD MEDICARE
PAC02992Medicare UPIN