Provider Demographics
NPI:1518796440
Name:KATAMANI, ERIC (RN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KATAMANI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-4703
Mailing Address - Country:US
Mailing Address - Phone:518-308-5349
Mailing Address - Fax:
Practice Address - Street 1:2 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-4703
Practice Address - Country:US
Practice Address - Phone:518-308-5349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692412163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1528125069Medicaid