Provider Demographics
NPI:1740257393
Name:MORTATI, KATHERINE A (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:MORTATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 EAST 34TH STREET
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4972
Mailing Address - Country:US
Mailing Address - Phone:212-263-8870
Mailing Address - Fax:212-263-8342
Practice Address - Street 1:403 EAST 34TH ST 4TH FLOOR
Practice Address - Street 2:NYU COMPREHENSIVE EPILEPSY CENTER
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10016-4972
Practice Address - Country:US
Practice Address - Phone:212-263-8870
Practice Address - Fax:212-263-8342
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2356982084A2900X
NYBM92075882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35048Medicare UPIN
615N41Medicare ID - Type Unspecified