Provider Demographics
NPI:1780960559
Name:KATZ, MARSHALL (CO)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOFSTRA CT
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1813
Mailing Address - Country:US
Mailing Address - Phone:516-380-0185
Mailing Address - Fax:516-829-1488
Practice Address - Street 1:800 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5340
Practice Address - Country:US
Practice Address - Phone:516-829-6188
Practice Address - Fax:516-829-1488
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACO1909222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist