Provider Demographics
NPI:1649983289
Name:STORER, KATARINA R
Entity type:Individual
Prefix:MRS
First Name:KATARINA
Middle Name:R
Last Name:STORER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4123
Mailing Address - Country:US
Mailing Address - Phone:631-682-5817
Mailing Address - Fax:
Practice Address - Street 1:17 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-4123
Practice Address - Country:US
Practice Address - Phone:631-682-5817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist